Abstracts

Abstract

Keynote Speaker Abstracts Placebos, Words, and Drugs: Sharing Common Mechanisms of Action Fabrizio Benedetti, MD1, 2 1Plateau Rosà Laboratories, Center for Hypoxia, Plateau Rosà, Italy/Switzerland 2Department of Neuroscience, University of Turin Medical School, Turin, Italy Abstract Although placebos have long been considered a nuisance in clinical research, today they represent an excellent model to understand how words and therapeutic rituals may affect the patient’s brain. Placebo effects, and their evil twins, nocebo effects, are today an active and productive field of research, and because of the involvement of many mechanisms, the study of the placebo effect can actually be viewed as a melting pot of concepts and ideas for neuroscience. Indeed, there exists not a single but many placebo effects, with different mechanisms and in different systems, medical conditions, and therapeutic interventions. For example, brain mechanisms of expectation, anxiety, and reward are all involved, as well as a variety of learning phenomena, such as Pavlovian conditioning, cognitive, and social learning. There is also some experimental evidence of different genetic variants in placebo responsiveness. The most productive models to better understand the neurobiology of the placebo effect are pain and Parkinson’s disease. In these medical conditions, the neural networks that are involved have been identified, that is, opioid, cannabinoid, cholecystokinin, cyclooxygenase, and dopamine modulatory networks in pain and part of the basal ganglia circuitry in Parkinson’s disease. Important clinical implications emerge from these recent advances in placebo research. First, as the placebo effect is basically a psychosocial context effect, these data indicate that different social stimuli, such as words and therapeutic rituals, may change the chemistry and circuitry of the patient’s brain. Second, the mechanisms that are activated by placebos are the same as those activated by drugs, which suggest a cognitive/affective interference with drug action. Therefore, by taking all these data together, today we can talk of a true pharmacology and toxicology of words, whereby the unique and special interaction between the therapist and his/her patient can activate the same mechanisms that are the target of drugs. How Nutrition Can Impact Gut Microbiome Composition, Intestinal Permeability, and Antigen Trafficking Leading to Chronic Inflammatory Diseases Alessio Fasano, MD1,2,3 1Mucosal Immunology and Biology Research Center, Massachusetts General Hospital for Children, Boston, Massachusetts 2Harvard Medical School, Bosten, Massachusetts 3European Biomedical Research Institute Salerno, Salerno, Italy Abstract Improved hygiene leading to a reduced exposure to microorganisms have been implicated as 1 possible cause for the “epidemic” of immune-mediated diseases, particularly noninfective chronic inflammatory diseases (CIDs), in industrialized countries during the past 3–4 decades now affecting millions of individuals. The social and financial burdens imposed by these chronic, debilitating diseases include poor quality of life, high health-care costs, and substantial loss of productivity. That is the essence of the hygiene hypothesis that argues that rising incidence of these pathologies may be, at least in part, the result of lifestyle and environmental changes that have made us too “clean” for our own good. Interestingly, increased hygiene in some developing countries did not lead to an increase in CID as seen in industrializing countries, casting some doubts on the validity of the hygiene hypothesis. Apart from genetic makeup and exposure to environmental triggers, 3 more elements have been recently identified being key players in the pathogenesis of CID. A third element is the inappropriate increase in intestinal permeability, which may be influenced by the composition of the gut microbiota, has been proposed in the pathogenesis of these diseases. Intestinal permeability, together with antigen (Ag) sampling by enterocytes and luminal dendritic cells, regulates molecular trafficking between the intestinal lumen and the submucosa, leading to either tolerance or immunity to nonself Ag. This tolerance-immune response balance is influenced by the function of the immune system (both innate and adaptive immune response) as a forth element involved in the pathogenesis of CID. Finally, the composition of gut microbiome and its epigenetic influence on the host genomic expression has been identified as a fifth element in causing CID. The gut microbiome consists of more than 100 trillion microorganisms, most of which are bacteria. It has been just recently recognized that there is a close bidirectional interaction between gut microbiome and our immune system, and this cross talk, particularly during infancy, is highly influential in shaping the host gut immune system function and, ultimately, the tolerance/immune response balance. This observation led to a revisitation of the possible causes of CID epidemics. With the appreciation that the gut microbiome plays a decisive role in either generating (mucosal) tolerance or leading the way to the development of inflammatory conditions, alternative hypothesis has been formulated. There is growing evidence that many CID are characterized by a change in microbiome composition. While factors such as modality of deliver, neonatal feeding regimens, use of antibiotics, and infections can influence microbiota composition, diet is by far the most important variable affecting gut ecosystem. Therefore, reshaping gut microbiota through dietary manipulation is becoming an extremely active area of research for the prevention or treatment of a multitude of CID. Celiac disease and autism spectrum disorders will be discussed as clinical examples of this new paradigm. The Radical Redesign of Health Care: The Why, What, and How Tracy Gaudet, MD1 1Department of Veteran Affairs, National Office of Patient-Centered Care and Cultural Transformation Abstract The mission of the Veterans Health Administration (VHA) is “To honor America’s Veterans by providing exceptional health care that improves their health and well-being.” In keeping with this, VHA has made a commitment to innovate the way health care is delivered by leading the expansion of the current medical paradigm—which is historically predominantly disease based and reactive—to one that is personalized, proactive, and patient driven. It is not difficult to reflect on a time, either in the course of one’s practice or one’s own experience of health care, when the typical medical model fell short—when a diagnostic and procedural approach failed to identify an issue, resolve the root of the problem, or move the person closer to their own goals for well-being. In response, health-care professionals in America have begun to examine a more comprehensive, holistic approach to health care would serve us—as both practitioners and patients—better. How, then, do we get from the current state to this patient-driven model? The core elements of this approach as well as the demonstrations underway and the plan for national implementation across the The Radical Redesign of Health Care: The Why, What, and How VA will be presented. Specifically, this presentation will delineate the core drivers for the transformation of health care, define the critical elements of a health-care system that is designed to empower and equip people to optimize their health and well-being, and describe examples of current demonstrations of this approach and lessons learned. Connective Tissue: Putting the Body Back Together Again Helene Langevin, MD1 1Osher Center for Integrative Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts Abstract Connective tissue forms a whole-body network that “connects” the body’s cells, tissues, and organs with one another. The same connective tissue that transmits mechanical forces within the musculoskeletal system also constitutes the “terrain” where immune responses take place. Dr Langevin’s research shows that connective tissue can function as a bridge between the musculoskeletal system and the immune system. This connection helps us understand how mechanical forces produced during acupuncture-, manual-, and movement-based therapies can influence immune processes such as inflammation. Dr Langevin’s presentation will highlight the development of methods for controlling the “dose” of forces applied to tissue in animal models has been key to advancing this field. She will also discuss how understanding connective tissue can help us overcome the artificial fragmentation of the body that handicaps modern physiology and medicine. Bringing the Body Back Into Mind–Body Research Peter Wayne, PhD1 1Osher Center for Integrative Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts Abstract Mind–body practices have evolved to target and take advantage of the interconnectivity between the body and mind, with the goal of enhancing system-wide health. Significant progress has been made in exploring the impact of mind–body therapies on brain structure and function, clinical measures of cognition, and patient-reported outcomes related to affect and quality of life. However, surprisingly little research has explored the use of practical, body-based functional outcomes to inform more holistic concepts of mind–body health. Research supports that body-based outcomes (eg, gait speed, gait rhythm, and postural control) are effective biomarkers and predictors for multiple domains of health including cognition, affective disorders, fall risk, heart disease, and all-cause mortality. This talk will draw on key principles from the field of embodied cognition to make a case for including measures of physical performance and shape to characterize overall health and to better understand the contributions and relevance of top-down processes such as executive function, attention and affect to physical function and whole person health. Research related to the impacts of multimodal mind–body exercises (eg, Tai Chi and Qigong [TCQ]) on functional outcomes will then be summarized within an embodied cognition framework. This research includes studies employing dual tasking (cognitive challenges during gait and balance tasks) which support that TCQ enhances cognitive-motor integration during activities of daily living, and studies demonstrate that TCQ’s impact on anxiety and affective disorders can be observed through quantitative and qualitative changes in gait and posture. Opportunities afforded by new technology to assess gait and other embodied outcomes in both laboratory and ecological settings, including wearable sensors and gait monitoring systems are highlighted. Challenges inherent in using multimodal interventions for studying cross-systems outcomes are also discussed. The Need for an Integrated Approach to Understanding the Determinants of Health Steven H. Woolf, MD, MPH1 1VCU Center on Society and Health, Virginia Commonwealth University Center, Richmond, Virginia Abstract Integration is important not only to how we define health and wellness (eg, integrative health) or deliver care (eg, integrated team care) but also to how we understand the complex web of factors that shape health. Society tends to equate health with health care, but our health is determined greatly by health behaviors (eg, smoking, sedentary activity), lifestyle, and stress. These in turn are shaped by upstream factors including socioeconomic conditions (eg, education, poverty, income inequality) and the physical and social environment in which we live. The physical environment includes not only clean air and water but also a built environment that enables active living and heathy food choices, healthy and secure housing, and affordable transportation. The social environment also affects health, as when people experience trauma or toxic stress from racism, residential segregation, exclusion, social isolation, or loneliness. Macrostructural factors—such as public policies, social values, and spending policies—function at the national, state, and local level to influence all of these downstream domains from socioeconomic and environmental conditions to the ability of people to obtain health care or maintain healthy behaviors. These multilevel relationships are notoriously interdependent, which means that meaningful efforts to improve population health require an integrated approach to policy and practice. For example, efforts to improve access to health care or employment cannot succeed if the people in need of these services lack stable housing, child care, or affordable transportation to reach the health-care facility or jobsite. Too often, clinicians, health systems, and communities attempt to improve health by targeting a single domain. These efforts are less likely to “move the needle” than cross-sector partnerships in which stakeholders work across sectors to achieve collective impact through collaboration. Integration is hard work; it requires commitment, resources, and infrastructure. But it is essential to achieve transformational change. Pre-Congress Workshop Abstracts (1106) Words That Harm and Words That Heal: How to Transform Language to Improve Clinical Encounters Dawn M Bellanti, MSN, FNP1 1MedStar Institute for Innovation, Kensington, Maryland Abstract Purpose: The purpose of this presentation is to illustrate the key lessons learned from placebo, nocebo, and hypnosis research; bring awareness to how our use of language in the field of health care has the power to both harm and heal; and provide practical ways to reframe our choice of words from the negative to the positive to improve encounters in our professional and personal encounters. This presentation seeks to translate key findings from integrative medicine research into clinically relevant actions, in alignment with the conference’s goals to improve interprofessional collaboration. Objectives: Following this presentation, attendees will be able to paraphrase the lessons learned from placebo, nocebo, and hypnosis research in order to interpret the key message: that our choice of words deeply influences others in both positive and negative ways; appraise whether they have been unknowingly using negative languaging in personal and professional conversations in order to judge the relevance of this information to them as individuals and health-care providers; and interpret the personal meaning and value of the information learned in order to implement more positive languaging in the future. Outline: Presentation Overview: 1. Introduction and learning objectives 2. How “medical-eze” unintentionally harms (high-tech terminology, fear-inducing metaphors, outdated insensitive language, gallows humor) 3. Why our words matter: the nocebo response 4. Leveraging lessons from placebo research 5. Top 8 “words to lose” and “words to use” 6. Therapeutic languaging during patient encounters 7. Putting it into practice: Two role-playing scenarios demonstrating “words that harm” and “words that heal” (1165) Nonrandomized Pragmatic Controlled Trials Supplement Randomized Controlled Trails in Comparative Effectiveness Research Franz Porzsolt, MD, PhD1 and Christel Weiss PhD1, 2 1Institute of Clinical Economics e.V., Ulm, Germany 2Medical Statistics, Campus Mannheim, Univ Heidelberg, Mannheim/Heidelberg, Germany Abstract Purpose: Archie Cochrane asked 3 essential questions: “Can it work?” “Does it work?” and “Is it worth it?” The purpose of my presentation is to show that the first question requires a efficacy trial (research under ideal study conditions), while the second and third questions require an effectiveness trial (research under real-world conditions). Objectives: The objective will be to elucidate the difference between efficacy and effectiveness trial. Outline: There are significant differences between randomized controlled trials (RCTs) and pragmatic controlled trials (PCTs). The following are unique to PCTs (compared to RCTs), and I would discuss them further in my presentation: • PCTs do not differentiate between primary and secondary outcomes as PCTs are descriptive but not explanatory trials. • PCTs do not have exclusion criteria as any patient who meets the inclusion criteria will be served under RWC. • The definition of all important risk factors that influence the outcomes of any investigated end point is essential for generation of the risk-stratified subgroups. • Any used treatment option will be accepted as any of the selected treatments is considered ideal for the individual patient and condition. • An informed consent is necessary for systematic and anonymous collection and publication of data but not for the selection of approved treatments based on doctor/patient preferences. • Comparative effectiveness analyses are confined to large-size patient groups. • Recorded data of all groups that are too small for single-group evaluations are combined to a “any other treatment group” that serves as “nonspecific control group” for comparison with the specific interventions. • No intent-to-treat evaluation is necessary as the patients were stratified to risk-specific baseline subgroups. This dichotomous evaluation strategy will change the theory, the ethical assessment, the practice, the edition of clinical guidelines, and legal aspects of health-care research. (1170) Making the Business Case for Integrative Health: Practical Application of Economic Evaluation Patricia M. Herman, ND, PhD1 and Claudia M Witt2 1RAND Corporation, Santa Monica, California 2University Hospital Zurich, University of Zurich, Zurich, Switzerland Abstract Purpose: The purpose of this workshop to give attendees a strong conceptual foundation on the use of economic evaluation (eg, cost-effectiveness, return on investment, and other types of cost analyses) to make the business case for complementary and integrative health approaches. Objectives: The objective of this study is to know the basic principles of economic evaluation, including the perspective of analysis, and the different types of economic evaluations and their strengths and limitations for use in establishing a business case; know how to identify and prepare effectiveness data appropriate for a business case and for inclusion in the different types of economic evaluations; and know how to determine types of cost data available to their study, including administrative and chart data, how to estimate implementation costs, and how all pieces come together in support of a business case. Outline: 1. Basic principles: presentation and whole group exercise looking at examples of published studies and critiquing them from the perspective of their support for a business case 2. Measures of effectiveness: presentation and individual exercise considering the likely measures of effectiveness that would be of interest to different business case audiences 3. Measures of cost and bringing it together: presentation and small-group work on final exercise where participants will calculate cost-effectiveness and return on investment from different perspectives (ie, of interest to different types of decision makers) and interpret their results as to their impact on a business case (3286) Applications of Narrative Medicine for Patient Identity and Quality of Life John L Villano, MD, PhD1 and Robert B Slocum, PhD1 1Lexington, Kentucky Abstract Purpose: The purposes of this workshop are to provide a basic introduction to narrative medicine and its applications for patient care, to apply and illustrate these understandings in case-based presentations on the clinical use of narrative medicine visits to assist brain cancer patients to recover or discover identity and sense of self as they receive treatment, and to provide an interactive and reflective narrative medicine-based experience for participants through a journal writing exercise with expressive writing prompts. Objectives: The aim is to describe and discuss basic principles and methods of narrative medicine, apply basic principles and methods of narrative medicine in clinical practice and interactions with patients through discussion of case histories, identify appropriate cases for application of narrative medicine principles and methods, and demonstrate understanding of narrative medicine methods by participation in a journal writing exercise with expressive writing prompts. Outline: I. Introduction to narrative medicine II. Application of narrative medicine principles and methods relative to case-based studies III. Journal writing exercise with expressive writing prompts (3339) Developing Your Research Career: National Center for Complementary and Integrative Health Training and Career Development Opportunities Lanay M Mudd, PhD1, Gloria Yeh, MD, MPH2, Jeffery A Dusek, PhD2, Wen Chen, PhD1, Ashlee Tipton, PhD1, Emmeline Edwards, PhD1, John Denninger, MD/PhD, MS3, Peter Wayne, PhD3 and Wendy Weber, ND, PhD, MPH1 1National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland 2Stockbridge, Georgia 3Boston, Massachusetts Abstract Purpose: The purposes of this workshop are to provide attendees with an overview of National Institutes of Health (NIH) training and career development funding opportunities, tips for successful grant submissions and review, and advice on key aspects of planning a successful research career with NIH funding. Objectives: The workshop will provide an overview of National Center for Complementary and Integrative Health’s (NCCIH) strategic interests in relation to training and career development opportunities by the Director of Extramural Research (Dr Emmeline Edwards). The NCCIH Training Officer (Dr Lanay Mudd) will provide an overview of training and career development funding opportunities, and a Scientific Review Officer (Dr Ashlee Tipton) will describe the review process. A mock study section consisting of some previous NCCIH reviewers (Dr Gloria Yeh, Dr Jeffrey Dusek, Dr John Denninger, and Dr Peter Wayne) will be used to illustrate key strengths and weaknesses commonly discussed when reviewing F and K applications. Breakout sessions specific to basic and mechanistic research or clinical research will discuss how to interact with NCCIH staff to develop your proposal, planning a research career and overcoming roadblocks, and how to find good mentors and collaborators. By the end of the workshop, participants will know NCCIH strategic priorities for clinical research and basic and mechanistic research; be able to develop a research career plan that links NCCIH funding opportunities to different stages of their career development; understand and be able to navigate the scientific review process at NIH; know when and how to interact with NIH staff to develop grant proposals; and be able to identify key characteristics of strong training and career development grant proposals. Outline: Didactic lectures with question and answer session for the first 80 min (includes a hands-on career timeline activity). Interactive mock study section for 30 min. Didactic lecture for 15 min. Interactive small groups with hands-on activities for last 55 min. (3418) Putting Different Perspectives Into a Holistic Picture—How to Design an Integrative Real Patient Conference Friedrich Edelhäuser, MD, PhD1, Christian Scheffer, MD, MME1, Diethard Tauschel, MD1, Peter Hinderberger, MD2 and Benjamin Kligler, MD, MPH3 1Faculty for Health, Witten Herrdecke University, Witten, Germany 2Ruscombe Mansion Community Health Center, Baltimore, Maryland 3New York, New York Abstract Purpose: The purpose of this study is to introduce participants to an integrative patient conference with a real patient present; demonstrate a systematic and collaborative approach to developing a diagnosis and a therapeutic plan on 4 different levels: body, life processes, soul, and spirit; and stimulate discussion on this approach as a conceptual integration of conventional medicine with different CAM methods. Objectives: Participants will be able to understand the potential power of an integrative real patient conference, describe the principles of a systematic 4-level approach to integrate different dimensions of diagnosis and therapy, and describe the key elements for success in using real patient conferences as an educational tool. Outline: A major and challenging goal of integrative medicine and health is to integrate different perspectives into a holistic framework. Frequently, different CAM methods are simply added to conventional medicine, but integration is lacking. Therefore, we suggest using a 4-level approach that integrates conventional medicine—which is typically focused on the physical dimension—with complementary/integrative-perspectives focusing on the 3 other levels (life processes, soul, and spirit). This will be the conceptual framework for the patient conference. In contrast to “paper cases” or simulations, real patient conferences offer specific opportunities to focus on the patient and his/her request for integrative health care; to perceive the different dimensions of health, illness and healing; to exercise essential perception skills; and to enhance experiential learning. The integrative real patient conference has been developed over the last 14 years at the Integrated Curriculum for Anthroposophic Medicine at Witten/Herdecke University and is practiced regularly at the Clinical Education Ward for Integrative Medicine. (3527) Using Health Coaching Skills to Enhance Patient Engagement and Autonomy Blaire Morriss, ANP1, Mark Dreusicke, MD1, Linda Manning, PhD1 and Ann King, MA2 1Nashville, Tennessee 2National Board of Medical Examiners, Philadelphia, Pennsylvania Abstract Overview: Informed, activated patients are essential to prevention and treatment of chronic disease. Emerging health-care delivery practices implicitly and explicitly demand that patients possess the skills to participate constructively in their care, achieve coordinated care, increase treatment adherence, and improve patient health outcomes. Yet clinicians are often either not trained to support patient behavior change or believe it would be much more time intensive than it needs to be. This experiential workshop will teach health coaching skills to practitioners of all types to deepen their ability to enhance patients’ autonomy, motivation, and ability to participate in their care. This workshop will provide clinicians with instruction and multiple practice opportunities to use health coaching skills to address patient desires and needs in the moment in a way that empowers behavioral change. Participants will learn to optimize intake forms to build patient autonomy and learn 7 key health coaching skills to enhance growth-promoting relationships that support behavioral change. These skills include mindful listening, agenda setting in clinical encounters, provision of accurate and meaningful reflections and summaries, affirmation of patient strengths and values, utilization of open-ended questions to empower patients, patient-centered education using Elicit-Provide-Elicit, and Brief Action Planning. Practitioners will also learn to identify patients in the precontemplation and contemplation stages of change and practice coaching skills to assist these patients to move forward in behavior change. The workshop will be highly experiential, with brief overviews provided to explain the rationale and use of each health coaching skill and demonstrations of how the skills fit together. Each skill will be demonstrated and practiced in clinically relevant scenarios using various configurations including dyads, triads, group practice, and use of a new digital communication tool. Objectives: After completing this workshop, participants will 1) understand the scientific and theoretical rationale for utilizing key health coaching skills to enhance patient autonomy and motivation to change behavior; 2) optimize intake forms to empower patients; 3) recognize the contribution of foundational health coaching skills (ie, mindful listening) to growth-fostering relationships that support behavioral change; 4) practice addressing patient desires and needs in the moment utilizing mindful listening and the other 6 additional health coaching and motivational interviewing skills. In these practices, participants will learn to  • facilitate agenda setting in clinical encounters,  • provide accurate and meaningful reflections and summaries,  • clarify and support patient strengths and values through affirmations,  • utilize open-ended questions to empower patients,  • use Elicit-Provide-Elicit to educate patients in a highly patient-centric manner, and  • support behavior change through Brief Action Planning. 5) “stack” or assemble the skills into usable formats in case-based practices; 6) formulate appropriate steps forward in patient behavior change by identifying patients in the precontemplation and contemplation stage of change and utilize appropriate skills from the workshop to target this stage of change; and 7) demonstrate the integration of their new skills using a digital communication tool. (3578) Medicinal Plant Walk at Jim Duke’s Green Farmacy Garden Andrea Miller, MS(c)1, Betsy Miller Costilo, MS1, Michael Tims, PhD1, Termeh Feinberg, PhD, MPH2 and Bevin Clare, MS1 1Maryland University of Integrative Health, Laurel, Maryland 2Center for Integrative Medicine, Baltimore, Maryland Abstract Purpose: The purpose of this workshop is to develop or strengthen skills in medicinal plant recognition, research, and use in clinical care. Dr Jim Duke’s work in cataloguing both ethnobotanical and scientific evidence surrounding the use of medicinal plants in the United States is unprecedented, and his medicinal plant garden is a unique bounty of the plants he has catalogued. Objectives: The audience will be guided in a medicinal plant walk and sensory tour around Jim Duke’s unique garden and will be encouraged to participate in herb-related inquiry through interactions with tour leaders and plants. The main educational outcome for this workshop is to increase participant knowledge of medicinal plants, including when in the life cycle a plant has the most medicinal properties, which has obvious implications for the efficacy of herbal preparations used among patients in clinical practice. Outline: Due to the wide variety of plants in the garden, as well as perceived variability of the future growing season, it is not possible to list specific plants which will be discussed. We will, however, prioritize discussion on plants that are commonly seen in clinical practice and will be open to answering questions on ethnobotanical background, current health applications, and potential interactions regarding other specific plants the audience may be curious about. (3621) A Little Evidence Goes a Long Way … How to Write a High-quality Case Report Melissa S Barber, MSc1 and David S Riley, MD2 1National University of Natural Medicine, Portland, Oregon 2Scientific Writing in Health and Medicine, Portland, Oregon Abstract Purpose: The purpose of this workshop is to orient clinicians and researchers on the case report writing and publishing process. Objectives: From this workshop, attendees will become familiar with the historical relevance and application of case reports, case report writing tools (ie, CARE Guidelines and Explanation and Elaboration document), published case report examples, critical evaluation skills for reading case reports, and steps to writing and publishing a case report. The overall objectives are to increase reporting from the point of care; support clinicians in writing a high-quality, publishable case report; and create greater interface between clinical and research communities. Outline: This workshop will include a presentation, group breakout sessions, and convening in a large group discussion. (3622) Smartphone, Dumb BioMechanics. Fascia-based Pain Relief for Modern Times David Lesondak, BCSI, AS1 1Pittsburgh, Pennsylvania Abstract Purpose: The purpose of this workshop is to provide the clinician or physician with the skills to effectively indentify and treat common musculoskeletal/myofascial pains associated with habitual cell phone usage. We will include both pathoanatomical (postural) identifiers as well as palpation-based assessments. Practical portion will teach how to target very specific structures directly, comfortably, and effectively. Objectives: The aim is to understand the fascia’s role as a tissue and as a sensory nervous system; learn the biomechanical principle of tensegrity in relation to the fascia and chronic postural deviations; identify the postural patterns of habitual cell phone use, including analyzing the myofascial relationships between the superficial front line and superficial back line; recognize the contribution of the deeper arm and chest to the symptomatic neck, shoulder, and arm pain; and learn 5 fascia-based approaches that provide immediate relief. Outline: 00:00–00:30—Introduction to fascia both as a tissue and a system. 00:30–01:00—Identifying common postural deviations and an overview of the underlying myofascial pathology. 01:00–02:30—Practical portion includes palpation and treatment for sternochondral fascia, scalenes, pectoralis minor, medial intermuscular septum, and suboccipitals. Diaphragm will be covered in demo and with participants if time allows. 02:30–03:30—Conclusions, questions, theoretical applications, and so on. (3810) Weaving Together Patient-centered Care, Integrative Health, and Self-care: The Whole Health Approach in Your Practice and Your Life Adam Rindfleisch, MD1, Bisty Recupero, MD, Michael Hollifield, MD, Aysha Saeed, MD, Theresa Liao, MD2, Carol Bowan, MD3 and Henri Roca, MD 1University of Wisconsin, Madison, Wisconsin 2Portland, Oregon 3Baltimore, Maryland 4Little Rock, Arkansas Abstract Purpose: We all agree that patient-centered, integrative, and self-care matter, but what does it look like to draw all of these elements of care into your day-to-day practice? How do you create a personalized health plan for each of your patients in a way that is both efficient and professionally fulfilling? For several years, the Veterans Health Administration (VHA) National Office of Patient-Centered Care and Cultural Transformation has been exploring practical implementation of a new way of offering care, using what they call the Whole Health approach. Over 5000 VA clinicians have received training in Whole Health, and as of October 2017, 18 different VA facilities will be implementing a Whole Health Systems model. The purpose of this preconference workshop is to familiarize participants with the model, but even more importantly, to teach them how to tailor the Whole Health approach to their own specific practices. Skill building and experiential learning are emphasized, and multiple supportive resources will be offered. The material from the VA’s national course, “Whole Health in Your Practice,” will be adapted for use by non-VA clinicians. This experience will enlist expertise from Whole Health educators nationwide and builds on information that will be featured in Dr Tracy Gaudet's plenary address. Objectives: After completing this workshop, participants will be able to describe the elements of Whole Health care, including the exploring meaning/aspirations/purpose with patients, the Circle of Health, and the key elements of Personal Health Planning; cocreate a personal health plan for themselves and for a partner, emphasizing core values, self-care, and complementary and integrative health approaches; describe how their own self-care practices are relevant in this approach to care; complete a Whole Health Assessment; discuss research findings relating to the efficacy of Whole Health care and its various components; list at least 5 online resources where they can get additional in-depth information about Whole Health; and describe 3 ways they will incorporate Whole Health more fully into practice after returning home. Outline: This 6-h session includes the following 9 modules, with short breaks in the middle of the morning and afternoon sessions and a longer break over lunchtime. Because faculty have taught these topics multiple times, it is possible for us to gauge timing fairly accurately for each of the 9 modules. 1. Introductions (30 min): Participant introductions, introduction Whole Heath at an individual, team, and system-wide level, with a focus on the Circle of Health and elements of Personal Health Planning. 2. Mindful awareness (30 min): Summary of latest research on mindfulness, with 5-min mindfulness experience and discussion of how to integrate it into daily clinical care. Each participant will assess their own clinical practice and self-care in terms of what is going well and where they would like to make improvements using 2 self-assessment instruments. Each person will complete a Personal Health Inventory. 3. Cultivating therapeutic presence (30 min): Experiential exercise related to reconnecting with reasons to enter a healing profession. Summary of research related to how clinicians can be most effective for their patients/clients based on nonspecific variables they bring into practice. 4. Self-care, part I (1 h): Participants will focus on 2 areas—healthy surroundings (optimal healing environments; 30 min) and resilience/personal development (30 min). They will complete an exercise related to key elements of a healing space with a small group discussion with a partner. They will have small group discussion on what contributes to resilience. Participants will each be assigned “health planning partners” and they will begin to do Whole Health assessments with each other, asking questions related to surroundings and personal development. 5. Self-care, part II (40 min), healthy lifestyle: Self-care tips and resources related to eating, activity, and sleep will be discussed. A guided movement meditation will be offered in the middle of the time. Participants will discuss these 3 aspects of self-care with their health planning partners. 6. Self-care, part III (40 min), healthy connections: Spirituality, relationships, and power of mind will be discussed, with an emphasis on research related to their roles in promoting health and well-being. Participants will share their perspectives on spirituality and clinical care with their small groups. They will practice taking a partner through a basic breathing exercise. They will discuss these 3 elements of self-care with their planning partners as well. 7. Professional care (40 min): The role of complementary and integrative health in practice will be discussed, with a focus on several of the most popular approaches used nationally. The VA now requires that several complementary approaches be provided by all VA sites, and this unique perspective will be discussed in a large group format. National resources to support professionals in Whole Health Practice will be shared. Faculty will demonstrate the overall model with a participant volunteer. 8. Implementation I (45 min): Working with their same partners, participants will finish creating, with step-by-step guidance, their Personal Health Plan. 9. Implementation II (45 min): Working in small groups, participants will discuss how to apply the Whole Health model in their own practices and share their ideas with the larger group. (3941) Honing Your Clinical Research Proposal for National Institutes of Health and National Center for Complementary and Integrative Health Funding Opportunities Martina Schmidt, PhD1, Dave Clark, DrPH, MPH1, Emmeline Edwards, PhD1, Wendy Weber, ND, PhD, MPH1 and Wen G Chen, MMSc, PhD1 1National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland Abstract Purpose: This workshop will provide attendees with an overview of how to develop an application to National Institutes of Health (NIH) or National Center for Complementary and Integrative Health (NCCIH) that includes human subjects. The session will focus on how to distinguish between developing a mechanistic study to determine how a complementary or integrative health intervention exerts its effect versus developing an intervention that will be tested to evaluate whether the intervention is beneficial for a given clinical condition or symptom. Attendees will learn about important changes to NIH funding opportunities and application forms, tips for successful grant submissions and review, and specific NCCIH funding opportunities that will support research with human subjects. Objectives: The workshop will provide an overview of NCCIH’s strategic interests in clinical research by the Director of Extramural Research (Dr Emmeline Edwards). The NCCIH Clinical Research Branch Chief (Dr Wendy Weber) will provide an overview of NIH policy changes related to clinical trials, and Clinical Research Branch Program Director (Dr Dave Clark) will present NCCIH funding opportunities for clinical trials focused on clinical outcomes. The NCCIH Basic and Mechanistic Research Branch Chief (Dr Wen Chen) will summarize how NCCIH encourages applicants to study the mechanisms of complementary and integrative health approaches and the funding opportunities available to support this type of research. A Scientific Review Officer (Dr Martina Schmidt) will describe key changes to the application forms and how they will impact the review process. Breakout sessions specific to human subjects basic and mechanistic research or clinical outcomes focused research will allow attendees to interact with NCCIH staff to discuss questions related to submitting an application to NCCIH and NIH generally. By the end of the workshop, participants will know NCCIH strategic priorities for human subjects research for both clinical outcome focused research and basic and mechanistic focused research; be able to identify which funding opportunity to use to submit a human subjects research application to NCCIH; understand how the NIH review process will evaluate the information submitted in the new NIH application forms; and understand recent important changes to NIH policy for clinical trials. Outline: Didactic lectures with question and answer (Q&A) session for the first 120 min (2:1 lecture to Q&A). Interactive small groups with hands-on activities for last 45 min. Oral Session Abstracts (64) Medicaton Cost Savings in an Inpatient Oncology Unit Using an Integrative Model Irene M Estores, MD1, Robert R Leverence, MD1, Lazarus Mramba, PhD1, Carrie Warring, MHS, MBA1, Lauren Arce, MSN2 and Andrew Hix, BS2 1University of Florida, Gainesville, Florida 2UF Shands Hospital, Gainesville, Florida Abstract Purpose/Background: Patients with a cancer diagnosis experience symptoms that reduce their quality of life and ability to complete treatment. Pharmacologic approaches alone are inadequate in fully controlling symptoms such as pain, anxiety, emesis, and insomnia. They also contribute to adverse events and do not promote self-empowerment. Nonpharmacologic approaches have been shown to improve symptom control and sense of well-being. However, more data are needed on related costs and outcomes. Objective: To determine the effect of hospital-based integrative medicine services on medication costs for opioids, benzodiazepines, and antiemetics in an adult hematology oncology unit. Results: Cost data were available for 111 hospital encounters for patients who received integrative services and 273 encounters for those who did not. Controlling for level of pain and length of stay, we found a decrease in average medication cost per day of 41% (P = .003) for the intervention group compared to a comparison group. Conclusions: An integrative medicine model delivered on an inpatient oncology unit that incorporates patient preference in care planning results in a relative drug cost reduction for opioids, benzodiazepines, and antiemetics. (1090) The Radical Redesign of Health Care: The Whole Health System Amanda Hull, PhD1, Alison M Whitehead, MPH1, Kavitha Reddy, MD1, Lauri Phillips, RDN, LD1, Jennifer Patterson, PhD1 and Maureen Khung, MPH1 1Bedford, Massachusetts Abstract Overview: With the opioid epidemic, veteran suicides, rising rates of chronic illness despite high expenditures, and provider burnout, it is time to radically reenvision and redesign health care to create a health-based, rather than disease-based, care system. We must expand our understanding of what defines health care and develop a Whole Health System (WHS) that empowers and equips individuals to discover a path to health and well-being. The Department of Veterans Affairs (VA) is uniquely positioned to make this a reality for veterans and our nation. The WHS has 3 components: (1) The pathway where peers partner with the individual and their family, exploring their mission/aspiration/purpose, and introduce personal health planning; (2) well-being programs focusing on skill building in support of self-care goals and including health coaching as well as proactive, complementary and integrative health (CIH) approaches; and (3) Whole Health Clinical Care that focuses on treatment with clinicians trained in whole health and includes changing the conversation, aligning health goals with life goals, delivering care through healing environments and relationships, CIH approaches, coaching, and personal health planning. The implementation of the WHS requires a large-scale education and deployment strategy for providers and staff, utilizing field implementation teams around the country to assist with local implementation and community partnerships. Eighteen design sites have been funded since Fiscal Year 16 (FY16) to pilot components of this system. Supported by the Comprehensive Recovery and Addiction Act legislation, VA has launched the implementation of the full system in 18 Flagship Facilities in FY18, which is the first wave in national deployment. Veteran engagement, activation, and satisfaction, utilization of resources and biometrics will be tracked, as well as the interface with opioid safety and suicide prevention. This session will review the WHS model of care and its implementation at sites across VA. Rationale: With the national opioid epidemic, veteran suicides, rising rates of chronic illness despite high expenditures, and health-care provider burnout, it is time to radically reenvision and redesign health care to create a health-, rather than disease, care system. The VA is unique in that it covers all aspects outlined in this year’s conference: research, education, clinical practice, and policy. Objectives: The aim is to describe 3 components of WHS, understand how to implement large-system transformation, and list key outcomes of success in whole health implementation. (1094) Developing Concepts for Information, Communication, Counseling, and Training of Health Professionals Who Are Involved in the Care of Cancer Patients Alfred Laengler1, Claudia M Witt2, Jan Schildmann3, Corina Guethlin, PhD4, Stefanie Joos5 and Markus Horneber6 1University Witten/Heredecke, Herdecke, Germany 2University Hospital Zurich, University of Zurich, Zurich, Switzerland 3Wilhelm Löhe University of Applied Science, Fuerth, Germany 4Johann Wolfgang Goethe University, Frankfurt am Main, Germany 5University of Tübingen, Tuebingen, Germany 6Paracelsus Medical University Klinikum Nuernberg, Nuernberg, Germany Abstract Overview: Communication of health professionals about “Complementary and Alternative Medicine” (CAM) in oncology, pediatric oncology, and primary care is important. The German Cancer Aid is funding the “Competence Network Complementary Medicine in Oncology” (KOKON) that consists of 20 academic institutions and works on 9 research projects. The overall goal is developing concepts for information, communication, counseling, and training of health professionals who are involved in the care of cancer patients. Prospectively, these concepts and offers should improve care for patients and their relatives and support physicians in their daily work. For this purpose, one focus is the systematic development and evaluation of training concepts for physicians. This symposium will present and discuss structure and content of the different training programs and share first results and lessons learned. Rationale: More than half of the cancer patients use complementary and integrative medicine. Many of them would like to get information about this topic from their treating physicians. However, oncologists and primary care physicians don’t feel particularly confident when discussing CAM-related topics. There is a demand for feasible, high-quality trainings for health professionals to develop knowledge and skills to inform their patients about CAM. KOKON develops and evaluates 3 blended-learning (e-learning and on-site workshop) training programs for physicians. Objectives: The symposium will provide an overview about the content and structure of the 3 newly developed training programs for physicians (medical oncologist and gynecological surgeons, general practitioners, and pediatric oncologist) and the rationale for the methodological steps taken during the development. First results and leasons learned will be shared. Furthermore, the overall aims and impact of the competence network complementary medicine in oncology will be presented and discussed. Outline: Introduction/Aims of the Workshop A. Längler; C.M. Witt (5 min) Overview KOKON network M. Horneber (10 min) The multidisciplinary Competence Network “Complementary Medicine in Oncology—KOKON” aims to improve standards for evidence-based information, communication, and training through systematic research and collaborative partnership of 20 universities and academic institutions of all areas of cancer care. CAM training for general practitioners C. Guethlin, S. Joos (10 min) Based on a questionnaire addressing training needs, we set up a blended-learning training to enable GPs to talk about CAM with their cancer patients. The training consists of (1) e-learning modules addressing definitions, concepts of a variety of CAM options, and research results of the most prominent CAM therapies in general practice and (2) a very practical workshop helping GPs to talk about CAM options will be another part of the blended-learning training. The training will be evaluated by means of a randomized pilot study. CAM training for medical oncologist and gynaecological surgeons C.M. Witt (10 min) A blended-learning training (9 × 45 min e-learning plus 2 days onsite workshop) for medical oncologist and gynaecological surgeons to inform their patients about CAM has been developed and is under evaluation in a cluster-randomized trial. A total of 40 physicians will inform 400 patients (10 each), effectiveness evaluation will take place in 3 settings (after the e-learning, during the workshop, and after physicians interacted with their patients). We will share first results and lessons learned. CAM training for pediatric oncologists A. Längler (10 min) In close cooperation with the projects “general practitioners “and “medical oncologist and gynaecological surgeons,” this module develops specific e-learning materials for the target group of “pediatric oncologists.” Results of an expert survey as well as literature search are the basis for the e-learning materials. The contents of the e-learning are based upon individual frequently used or demanded treatment methods as well as on symptom-oriented treatment strategies of integrative medicine in pediatric oncology. In addition, a practice workshop with actor patients will be developed in which pediatric oncologists deal with special decision-making and counseling situations. Decision-making about complementary and integrative medicine. An empirical-ethical analysis and guidance for consultation with cancer patients J. Schildmann (10 min) Requests about complementary and integrative medicine (CAM) form a frequent and at the same time challenging part of consultations with patients with cancer. In this paper, we provide a findings from an interdisciplinary analysis of experts in clinical medicine, medical ethics, and psychology on challenges regarding CAM in oncology, general practice, and pediatric oncology. Based on content analysis of qualitative research (ie, documentation and interviews with physicians and patients) in combination with normative analysis, we present perceived needs regarding CAM knowledge and skills and provide guidance and underlying rationales for professional strategies to deal with CAM associated challenges within the patient–physician encounter. (1119) Genomic, Neural, and Allostatic Assessments Reveal Similarities and Differences Among Mind–Body Interventions Manoj Bhasin, PhD1, John Denninger, MD2, Elizabeth Hoge, MD3 and Sara Lazar, PhD3 1Beth Israel Deaconess Medical Center, Boston, Massachusetts 2Massachusetts General Hospital, Boston, Massachusetts 3Charlestown, Massachusetts Abstract Overview: Little is known about how mind–body approaches differ in terms of mechanisms of action. Combining experimental methodologies can reveal commonalities and differences that have implications both for understanding the approaches themselves and for designing studies to test them. The 4 speakers are collaborating on a randomized clinical trial (RCT) (n = 211 healthy but stressed adults) that compares the mechanistic basis of a yoga-based, a meditation-based, and an attention control education-based program. Using the results of this study as a use case, presenters will discuss the mechanistic and study-design implications for mind–body interventions. Rationale: Growing evidence suggests that mind–body programs may utilize different mechanisms of action. These differences may have profound implications for choosing the right methodologies to test treatments and, ultimately, selecting the right treatments for our patients. Objectives: Participants will be able to (1) explain how combining methodologies can reveal commonalities and differences among mind–body programs, (2) compare the underlying mechanisms of yoga and meditation, and (3) describe the broader mechanistic and study-design implications for mind–body programs. Outline: The first speaker will frame the general problem of choosing the best outcome measures for mind–body medicine studies and discuss the rationale, design, and psychological findings of the RCT. The second speaker will discuss findings from the allostatic load data, a composite measure used to assess the effects of stress on multiple systems. The third speaker will present findings on genomic and epigenomic changes in response to the 3 programs and, combining these with findings from studies of massage and exercise, will discuss pathways that change exclusively in mind–body programs. The fourth speaker will discuss changes in neural structure and function associated with each program, as well as changes associated with 2 other mind–body programs. The speakers will also discuss the relationship between the measures and the power of integrating them for investigating mind–body interventions. (1144) Avoid the Struggle: Empowering Your Most Complex Patients to Make Sustainable Health Behavior Change Caryn Seebach, PsyD1 and Alyssa Adams, PsyD2 1Thomas Jefferson University, Philadelphia, PA 2Washington, DC Abstract Overview: Integrative medicine (IM) providers encounter some of the most complex patients. These patients often present with multiple comorbid conditions and may feel psychologically overwhelmed and disempowered. There can be a high burden of responsibility placed on the IM health-care provider to transition the patient from disillusioned to an active participant in his/her own health care. This workshop will provide practical, applied approaches to effectively support the biopsychosocial needs of even the most complex patients. The theory and research supporting sustainable health behavior change will be reviewed and clinicians will learn techniques grounded in health coaching, positive neuroplasticity, and motivational enhancement that can be directly applied in the next patient encounter. Providers will also explore their own subjective reactions to complicated patients and how they impact the clinical encounter. Rationale: The cornerstone of IM is treating the whole person, which necessitates a grounded understanding of behavioral medicine principles that foster sustainable health behavior change. A growing proportion of patients with complicated emotional and physical concerns are seeking IM providers. This workshop is designed to support the IM clinician in facilitating the patient’s transition from disempowered and frustrated to empowered and hopeful using a health psychology framework. IM and functional medicine training programs typically teach basic patient–provider communication skills, but this workshop is designed to delve deeper into the nuances and common barriers that many clinicians face during real-world implementation with complex patients. The instructors have an extensive and varied background in clinical health psychology, nutrition, and health behavior change and have worked with many complex and challenging patients with chronic health issues. Purpose: To provide evidence-based support, guidance, and skill building to IM providers working with their most challenging cases (eg, multiple comorbidities, externalizing patients, passive/disempowered patients). Objectives: The aim is to identify various models of health behavior change, assess patient stage of change and identify the appropriate intervention to match, explore personal reactions to difficult patients and resultant impact on the clinical encounter, and hone communication and health behavior change skills. Results: Providers will have an understanding of the extant research regarding patient–provider communication with complex patients, communication tools for facilitating health behavior change, and countertransference. Conclusions: Patients with complex presentations are likely to seek the care of IM providers, which requires IM providers to communicate in a way that facilitates health behavior change, empowers the patient, and maintains awareness of their own personal reactions to difficult patients. At the end of this workshop, providers will have identified various models of health behavior change, assessed patient stages of change and how to identify the appropriate intervention to match, explored their personal reactions to difficult patients and the resultant impact on the clinical encounter, and honed their communication and health behavior change skills. Outline: Background and evidence base 1. The empirical study of nonadherence, what the research says 2. What is health psychology and how it applies? 3. The empirical tenets of health behavioral change Models of care in health behavior change 1. A new understanding of why change is possible • Positive neuroplasticity • Foundational principles of health coaching • The role of motivational enhancement Applied skills 1. The “holding” environment 2. Assessment and alignment with patient’s stage of change 3. Tools for externalization and the “yes, but” patient 4. Assessment and strategies for illness and identity 5. Techniques for empowerment and shifting responsibility to the patient 6. Awareness and management of subjective clinician experience and countertransference Group experiential exercise/discussion (1153) Assessment of the Analgesic Properties of Auriculotherapy in Patients Undergoing Carpal Tunnel Surgery Carine Chaix-Couturier, MD, PhD1, Christian couturier, MD2 and Henri Weckmans, MD2 13C-Santé, Meudon, France 2Clinique Arago Paris, Paris, France Abstract Purpose: Effective perioperative pain management of patients undergoing hand surgery is critical because of the risk of postoperative of algodystrophy. In the present context of increase concerns of opioid addiction associated with surgery, increase considerations have been given to the use of complementary approaches including auriculotherapy (AT) for perioperative pain management. This study was designed to assess the analgesic properties of AT in patients undergoing carpal tunnel surgery. Results: The use of AT was associated with a significant decrease in postoperative pain. Graph is attached below. POD# 1, 2, and 3 was 1, 0.7, and 0.8, respectively, in group 1 versus 3, 2, and 0.6 in group 2 (P < .005). Postoperative analgesic consumption was similar in both groups. At 21 days, no patient required any analgesic medication. Conclusions: This preliminary study suggests that AT represents an effective complementary approach to control postoperative pain following carpal tunnel. Further investigations are required to confirm these findings. (1160) Is Mindfulness Immeasurable? Discovery and Dialogue of Conceptual, Practical, Scientific, and Experiential Solutions David Victorson, PhD1, Eric Garland, PhD2, Adam Hanley, PhD2 and Carol Greco, PhD3 1Chicago, Illinios 2Center on Mindfulness and Integrative Health Intervention Development, Salt Lake City, Utah 3Pittsburgh, Pennsylvania Abstract Overview: Mindfulness-based interventions (MBIs) have a prominent place in public health and clinical research, yet a significant gap still remains in mindfulness research: the lack of a comprehensive and standardized self-report measurement system. Due to the sheer number of available mindfulness measurement tools, each measuring different concepts in different ways, it is difficult to establish whether MBI participants actually develop mindfulness skills and attitudes, whether health outcomes can be attributed to intervention gains, and whether mindfulness itself is the active ingredient in MBIs. Due to this veritable “mindfulness alphabet soup,” it is not possible to compare findings from one trial with another. Further, “response shift” can add to confusion when one experiences a recalibration in understanding of what mindfulness is after being exposed. In other words, there is a paradox inherent in mindfulness measurement—if one is not mindful, how can one be aware enough to assess their degree of mindfulness? And, it is only when one becomes more mindful through training that they can begin to recognize when they are not exhibiting mindfulness. This symposium session will address this topic through 3 presentations focusing on (1) challenges and possible solutions to measuring mindfulness and related constructs drawing from the Patient-Reported Outcomes Measurement Information System (PROMIS); (2) psychophysiological alternatives to assessing mindfulness via self-report; and (3) a brief overview of the methodology and focus group findings of a new National Center for Complementary and Integrative Health (NCCIH)-funded R01 entitled Creating and Optimizing Mindfulness Measures to Enhance and Normalize Clinical Evaluation-R01AT009539, including experiential practice and dialogue on some of the big questions surrounding mindfulness measurement. Rationale: The scientific premise behind this symposium is that it will generate important knowledge and discussion surrounding mindfulness measurement and how PROMIS and other methodologies can help enhance and standardize future efforts and ultimately reshape the mindfulness measurement landscape. Objectives: After attending this session, participants will be able to describe common measurement challenges for mindfulness and related constructs; identify ways in which PROMIS-based methodologies (eg, item development, item response theory, item banking, computer-adaptive testing, score linking) can help enhance and standardize mindfulness measurement; recognize common real-world lessons learned from clinical trials research experiences; increase understanding of a new NCCIH-funded effort to improve mindfulness measurement; and engage in critical reflection and dialogue around these issues. Outline: A. Introduction B. Presentation I: Mindfulness and meditation-induced states of consciousness as outcomes in integrative clinical trials research: lessons learned from the trenches. This talk will provide real-world examples from several clinical mindfulness studies, as well as new data from novel measures of deeper meditative states, including nondual awareness. C. Presentation II: Challenges and possible solutions to measuring mindfulness and related constructs. This talk will provide an overview of some of biggest challenges to measuring mindfulness and transition to some possibly solutions based on item response theory methods and score linking/equating. D. Presentation III: Highlights from the NCCIH-funded COMMENCE R01. E. Question and answer, dialogues and experiential practice on some of the big questions surrounding mindfulness measurement. F. Summary and conclusion (2169) Tools to Encourage Resiliency in Health-care Providers and Educators Audrey J Brooks, PhD1, Hilary McClafferty, MD1, Patricia Lebensohn, MD1 and Mari Ricker, MD1 1Tucson, Arizona Abstract Overview: The University of Arizona Center for Integrative Medicine developed an interactive, online Healthcare Professional Wellbeing curriculum. The Wellbeing curriculum focuses on building resiliency skills, teaching mindfulness techniques, and reflection activities that help reduce stress and decrease burnout. We will describe how we piloted the curriculum in multiple primary care educational training programs and community health centers. We will describe our experience piloting the curriculum with residency programs within our institution, collaborating with leaders across the organization, and implementing a large scale, multispecialty Resident Wellbeing Training Program. We will explore the lessons learned from these endeavors and review our outcome data from this pilot program in the areas of hardiness, resiliency, gratitude, and burnout. Participants will explore their own self-care challenges and learn skills from the curriculum to improve their resiliency. Participants will discuss feasibility to implement the changes in their lives and how to adapt the program to their own institutions and how they can most effectively act as agents of change within organizations. Emphasis will be placed on the need to address burnout prevention and wellness promotion among all heath care professionals, and at all levels of a health-care organization, for meaningful change in the culture of burnout to occur. Rationale: Burnout is highly prevalent and exceeds 46% among all specialties. Residency programs have been mandated to address these unacceptably high burnout levels, and are in need of effective tools to help address burnout and promote well-being and resilience, and to teach residents the lifelong skills to prevent future burnout. Accreditation Council for Graduate Medical Education has also identified physician well-being and the need to create transformative changes in the culture of medicine as a top priority to be addressed by Graduate Medical Education. However, focusing efforts on the individual resident is insufficient, change in attitudes must occur at all levels, in every type of health-care professional, and across the organizational structure for meaningful change in burnout prevention to occur. Therefore, programs are urgently needed to address underlying culture of burnout and unrealistic endurance in organizations, in conjunction with individual education and skill building in residents, faculty, and other health-care professionals. The Healthcare Professional Wellbeing Course is designed to accomplish these objectives and was piloted with primary care educational training programs, with residents at a large academic institution, and with clinicians and staff at community health centers for this purpose. Objectives: The aim is to identify 4 elements of an evidence-based approach to health-care professional well-being, list 3 interactive activities that can be implemented in the academic and/or clinical settings to build resiliency skills, and formulate the first steps of an action plan to begin to implement well-being activities personally and within your education or work setting. Outline: Drs Ricker and Lebensohn will provide an overview of the Healthcare Professional Wellbeing Course, detailing the components of the course that guide participants to building resiliency skills, learn mindfulness techniques, and practice reflection activities that help reduce stress and decrease burnout. Dr Brooks will provide an overview of the evaluation results, reviewing our outcome data in the areas of hardiness, resiliency, gratitude, and burnout. Dr McClafferty will discuss the distinction between resiliency versus burnout and moderate participant completion of wellness and self-care assessments. Drs Lebensohn, McClafferty, and Ricker will lead 3 breakout groups teaching resiliency practices from the course. Dr Lebensohn will moderate a discussion on feasibility of implementing resiliency practices and self-care strategies personally and within organizations, and how to act effectively as agents of change within organizations. (2201) Listen to Your Body: A Multidimensional Assessment of Interoceptive Awareness for Mind–Body Research Adam Hanley, PhD1, Eric Garland, PhD1, Emily Stern, PhD2, Wolf E Mehling, MD2 and Cynthia J Price, PhD3 1Center on Mindfulness and Integrative Health Intervention Development, Salt Lake City, Utah 2San Francisco, California 3University of Washington, Seattle, Washington Abstract Overview: Interoception has been defined as the sensing of the physiological condition of the body. Interoceptive bodily awareness is emerging as a critical element for the understanding of mechanisms in mind–body research and psychological health. Mindfulness approaches include training in attention regulation toward breathing and other subtle body sensations. Alterations of interoception play a key role in psychological health, and integrative medicine approaches appear to be able to improve medical conditions through interoceptive training. Interoceptive awareness is ambiguous and can be clinically beneficial or maladaptive depending on the mode of attention, being either anxiety-driven or mindful. Scientific research in the field of interoception is still hindered by unresolved differences in the terminology of its multiple dimensions and the lack of strong measurements for research that are also meaningful to clinicians. Following a brief overview of the current terminology, the controversies around it, and available objective/behavioral and self-report measures, the presenters will focus on the MAIA and their research with this self-report measure, its usefulness and limitations. Rationale: Researchers in this field are just beginning to cooperate across the world. This symposium addresses the need for stronger collaboration among interoception and mind–body researchers to advance integrative health using mind–body approaches. The MAIA’s 20 translations may assist in international cooperation. Objectives: As a result of this session, participants will have learned about the concept of interoception, the complexity of its multiple dimensions, the current state of measurement development for rigorous research in the field of interoceptive body awareness, and will be able to make informed measurement decisions for research and clinic. Outline: Introduction: Wolf Mehling will introduce the speakers. He will clarify terms: bodily awareness, interoceptive awareness, interoceptive accuracy, interoceptive sensibility, mindfulness, and their place in mind–body therapies and contemplative practices. He will give a brief overview of measurements: objective and self-report. Emily Stern investigated neural mechanisms of interoception when 19 healthy individuals attended to their heartbeat and skin temperature and examined the relationship between neural activity during interoception and individual differences in self-reported interoceptive sensibility (IS) using the MAIA together with functional MRI brain imaging. IS represents the construct underlying the MAIA, here synonymous with interoceptive awareness, a multidimensional construct including not only the tendency to be aware of sensation but also how sensations are interpreted, regulated, and used to inform behavior, with different dimensions relating to different aspects of health and disease. Her data suggest that self-rated IS is related to altered activation in regions involved in monitoring body state, which has implications for disorders associated with abnormality of interoception. Cynthia Price will present data from an NIDA-funded clinical trial of mindful awareness in body-oriented therapy (MABT) for women in substance use disorder treatment. MABT is designed to teach interoceptive awareness and related skills for emotion regulation. The presentation will focus on the associations between baseline measures and the MAIA (N = 217), as well as the performance of the MAIA (ie, sensitivity to change) in response to the intervention. These results support prior neurobiological models and imaging research indicating the importance of interoceptive awareness for emotion regulation and the potential relevance to improved substance use disorder treatment outcomes. Eric Garland and Adam Hanley will present results from clinical studies using the MAIA with mindfulness-oriented recovery enhancement (MORE) from 2 separate RCTs: MORE in obese cancer survivors (N = 51) and MORE for opioid misusing chronic pain patients (N = 62). In both studies, MORE was associated with significant increases in multiple MAIA subscales and increases in self-regulation mediated the effect of MORE on reducing psychological distress. They will also present cross-sectional network associations between MAIA scales, dispositional mindfulness (Five Facet Mindfulness Questionnaire [FFMQ]) and Scales of Psychological Well-Being in healthy adults (N = 478). Wolf Mehling will present data from (1) a study of mindfulness-based cognitive therapy (MBCT) for comorbid depression and chronic pain (N = 31). Increases in the MBCT group were significantly greater than in the TAU group on the Self-Regulation and Not Distracting scales of the MAIA. Furthermore, the positive effect of MBCT on depression severity was mediated by “Not Distracting.” (2) In another study of integrative exercise (IE) using aerobic and resistance exercise with mindfulness-based principles and yoga provided improvements in PTSD intensity, quality of life improvements in mindfulness, interoceptive bodily awareness (MAIA), and positive states of mind in 47 war veterans with PTSD randomized to 12-week IE versus waitlist. Large effect sizes for the intervention were observed on FFMQ nonreactivity (d = 0.85), MAIA body listening (d = 0.80) and self-regulation (d = 1.05). Finally, he will provide an overview over shortcomings of the original MAIA, efforts to improve it and the use of the MAIA in its 20 translations in other countries. (2215) Role of Acupuncture in Integrative Medicine Helene M Langevin, MD1, Sanjay Reddy, MD1, Melinda Ring, MD1 and Chongbin Zhu, MD, PhD1 1Osher Collaborative for Integrative Medicine, Nashville, Tennessee Abstract Overview: Background: Acupuncture, as a specialty in Traditional Chinese Medicine, has been increasingly available within conventional health-care settings. There is growing evidence supporting the efficacy of acupuncture in conditions ranging from chronic pain to mood disorders. While more high-quality studies are warranted, the value of acupuncture as a component of health care is increasingly recognized by integrative medicine (IM) practitioners and patients. IM treatment plans often include recommendations for acupuncture. The role of acupuncture as part of the system of IM, however, has not been clearly defined. Program description: This proposal is to address and explore acupuncture-based model(s) of collaborative intervention for IM practitioners. Acupuncture is classically described as treating the whole person and will be explored on multiple levels. From our practices, we observe that acupuncture can improve symptoms, enhance quality of life, promote well-being, reduce unwanted side effects of conventional treatments, and shorten recovery time. We propose to explore several models of acupuncture-based integrative intervention and models for inclusion within inpatient and outpatient settings. We also propose to discuss the challenge of acupuncture-based models in research, education, and policy/regulation. Conclusion: Acupuncture-based integrative practice in our current health-care setting will benefit from guidelines. The challenges of acupuncture in the context of practice, research, and policy will be addressed, with recommendations to define its role in IM. Rationale: Although acupuncture has been proven effective in several pain conditions and is receiving increased attention due to the opioid crisis, the role of this unique modality in IM has yet to be defined. Acupuncture is most often used in collaboration with other interventions; however, there are no guidelines for IM or conventional health-care practitioners to refer patients to acupuncture-based integrative interventions. Additionally, there are significant challenges for acupuncture in research, education, and regulation/policy. In research, appropriate acupuncture controls and blinding can be problematic. In education, acupuncture, or IM as a whole, has not been endorsed by a majority of medical schools, although it is being increasingly discussed. In regulation/policy, the majority of insurance providers do not cover effective acupuncture treatment in most states in the United States, hindering the public access to acupuncture-based integrative intervention. The resolution to the aforementioned issues requires a collaborative effort from different fields. Our proposal is to address the above aspects to create recommendations that can influence policy and is relevant to the conference theme: collaboration in action. Objectives: Participants will know the role of acupuncture-based intervention in IM, commonly used models of acupuncture-based therapy, and possible mechanisms. They will also have increased clarity about the current challenges acupuncture practice faces in clinical care, research, and education. Through a panel discussion with audience engagement, speakers and participants will help work out some resolution via this program or provide direction for future resolution. Outline: 1. To define the role of acupuncture in IM and general health care. 2. To elaborate models of acupuncture-based integrative intervention. 3. To address challenges of acupuncture practice in clinic, education, and research. (2226) Neural Mechanisms of Manual Therapies for Chronic Pain Mark D Bishop, PT, PhD1, William R Reed, DC, PhD2, Laura Case, PhD3, Merav Sabri, PhD3, Partap S Khalsa, DC, PhD, DABCO3 and Helene M Langevin, MD4 1University of Florida, Gainesville, Florida 2University of Alabama at Birmingham, Birmingham, Alabama 3National Center for Complementary and Integrative Health, Bethesda, Maryland 4Osher Collaborative for Integrative Medicine, Boston, Massachusetts Abstract Overview: Manual therapies (MTs) are a class of nonpharmacological approaches that can be used for treatment and management of chronic pain. MT (eg, massage, mobilization, spinal manipulation) could be an alternative to, or used to reduce need for, prescription opioids. This is especially important given the current, national prescription opioid epidemic. However, the mechanisms by which MTs reduce pain are insufficiently understood, and this lack of understanding impedes their optimal utilization. Further, there is little consensus on the extent to which MTs modulate and/or modify neurophysiological responses in the peripheral and/or central nervous system (ie, brain and spinal cord), nor how neurophysiological responses might reciprocally affect peripheral tissues and/or immunological processes. This proposed National Center for Complementary and Integrative Health (NCCIH)-sponsored symposium will explore theoretically based research directions that focus on elucidating the peripheral and central neural mechanisms of MT, with the goal to achieve individualized mechanism-based pain management. The symposium will begin with a brief overview by the cochair, Dr Merav Sabri, on the NCCIH priorities for manual therapies. The first speaker, Dr Mark Bishop, will introduce a theoretical and testable framework of the mechanisms of MT. The second speaker, Dr Helene Langevin, will discuss the evidence and importance of peripheral mechanisms of MT. The third speaker, Dr William Reed, will present evidence and the importance of central mechanisms of MT. The fourth speaker, Dr Laura Case, will present research related to the sensory-affective neural mechanisms of massage. The symposium will conclude with a discussion moderated by the cochair, Dr Partap Khalsa. Rationale: MTs (eg, massage, mobilization, spinal manipulation) are a class of nonpharmacological approaches that can be used for treatment and management of chronic pain. Based on data from Centers for Disease Control and Prevention /National Center for Health Statistics National Health Interview Surveys (2002 and 2012), there is a significant increase in adult use of MT for pain management. MT could be an alternative to, or used to reduce need for, prescription opioids. This is especially important given the current, national prescription opioid epidemic. The mechanisms by which MT reduces pain are not well established. Consequently, clinicians are often challenged in selecting the most efficacious therapeutic approach for individuals with chronic pain. Mechanistic understanding of MT effects could facilitate the development and implementation of mechanism-based, individualized pain management, and identification of responders from nonresponders. Historically, local and segmental responses (eg, in tissue, structure) to MT were considered responsible for clinical benefit. This biomechanical approach could not explain the presence of nonsegmental hypoalgesia and autonomic function changes (eg, heart rate), bringing attention to neurophysiological responses to MT. However, there is little consensus on the extent to which MTs modulate and/or modify neurophysiological responses in the peripheral and/or central nervous system (ie, brain and spinal cord), nor how such responses might reciprocally affect peripheral tissues and/or immunological processes. There is evidence that MTs affect the interaction between inflammatory mediators and peripheral nociceptors in response to injury. In addition, changes in spinal excitability following MT, as indicated by decreased nociceptive flexion reflexes and reduced temporal summation, represent evidence for reduced facilitation and increased inhibition of nociceptive input as mediated by central descending pain modulatory systems. Still, direct evidence for spinal or cortical changes are weak and whether central nervous system plays a dominant or secondary role is unknown. The proposed NCCIH-sponsored symposium will explore theoretically based neuroscience research that focus on elucidating the potential peripheral and central mechanisms of MT, to facilitate the development of individualized mechanism-based pain management. The goals of this symposium are to (1) stimulate discussion among clinicians, physiologists, and neuroscientists; (2) facilitate collaborations on research of the neural pathways by which MT exert beneficial effects; and (3) promote optimization of MT. Objectives: The aim is to discuss the theoretical framework of MT mechanisms, assess the peripheral and central mechanisms underlying MT, and identify research gaps and discuss future research directions of the mechanisms by which MT work to alleviate pain. Outline: The proposed NCCIH-sponsored symposium will explore theoretically based research directions that focus on elucidating the peripheral and central neural mechanisms of MT, with the goal to achieve individualized mechanism-based pain management. The goals of this symposium are to (1) stimulate discussion among clinicians, physiologists, and neuroscientists; (2) facilitate collaborations on research of the neural pathways by which MT exerts beneficial effects; and (3) promote optimization of MT. (2227) Comparing the Effectiveness and Cost-effectiveness of Pharmacologic and Nonpharmacologic Options for Chronic Low Back Pain Patricia M Herman, ND, PhD Tara A Lavelle, PhD2 and John L Irwin, MPH1 1RAND Corporation, Santa Monica, California 2Boston, Massachusetts Abstract Purpose: Chronic low back pain (CLBP) is one of the most prevalent types of chronic pain and the subject of many randomized trials, each comparing 2 or 3 complementary and/or conventional medicine interventions. Economic simulation models offer one method by which the effectiveness of all (studied) interventions can be directly compared, and their cost-effectiveness determined even if costs were not included in the original study. Results: The intervention arms included in the models were limited to those with sufficient evidence: spinal manipulation, mobilization, acupuncture, massage, exercise, yoga, cognitive behavioral therapy (CBT), interdisciplinary rehabilitation, opioids, NSAIDs, injections, prolotherapy, and usual MD care. Based on available data for a typical CLBP cohort, the most effective interventions were yoga, flexion distraction (a type of mobilization), active trunk exercise, individualized acupuncture, and relaxation massage. However, the most cost-effective therapies were yoga, CBT, exercise, flexion distraction, and multidisciplinary rehabilitation. For a cohort with severe CLBP, yoga was still highly effective and cost-effective, but injections of different types (including prolotherapy) and spinal manipulation join the mix. Two studies of tramadol and one of prescription NSAIDs were included for the severe CLBP cohort (the only population in which we found usable studies of these) and compared poorly to the nonpharmacologic interventions. Conclusions: CLBP demands good strategies that are both clinically effective and financially responsible. These models provide useful flexible tools by which to examine what we know about the relative effectiveness and cost-effectiveness of the large number of interventions commonly used for CLBP under different assumptions and scenarios. (2253) Massage Perceptions and Experiences for Individuals With Amputations Nick Rattay, PhD1, Sarah Shue, MS2 and Niki Munk, PhD, LMT2 1School of Liberal Arts, Indiana University, Indianapolis, Indiana 2School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, Indiana Abstract Purpose: Massage therapy (MT) is self-reported by those with amputation as effective, but little MT research related to amputation exists. We sought to understand how people with amputations perceive MT in terms of expected outcomes and utilization. Results: N = 131 (n = 74 MT experienced) adults with amputation completed the study’s quantitative portion. N = 26 (n = 14 MT experienced) interviews were conducted. Qualitative analysis of transcribed interviews resulted in several primary themes. First, how clients perceive individual therapists impacts their perspectives on treatment. Second, clients have concerns with how MT is delivered, reflected in perceptions of value and potential utilization. Third, participants identified both general- and amputation-specific barriers and reported a range of positive and negative outcomes. MT experienced participants expressed desire to give back to the limb loss community specifically in relation to massage. Although massage perception and experience for those with amputation likely overlaps other populations, several amputation-specific findings are notable. Apprehension existed regarding the extent to which MT practitioners can address amputation-related complexity and presentation uniqueness. Confident and appropriate communication was identified as necessary traits for effective MT practitioners for clients with amputation. Conclusions: Study results combined with earlier MT practitioner population work and critical consideration of current MT education and practice may provide informative guidance to the field on how to best meet the limb loss community’s needs. (2255) Integrative East-West Medicine in the Academic Health Center Setting: The University of California, Los Angeles Experience Edward Hui, MD1, Lariza Johnson, MPA1, Sandi Chiu, MSOM, LAc1, Ka-Kit Hui, MD1, Andrew Shubov, MD1 and Justin G Laube, MD1 1Los Angeles, California Abstract Overview: When a group of University of California, Los Angeles (UCLA) resident physicians were given an introductory talk about integrative medicine (IM), their response was “ … isn’t that East-West medicine?” The Center for East-West Medicine (CEWM) is an academic clinical program within the UCLA Department of Medicine that is ingrained into the fabric of UCLA Health, an integrated health system in Southern California. CEWM was founded in 1993 by Ka-Kit Hui, MD, FACP, the current medical director, to blend the healing traditions of Traditional Chinese Medicine (TCM) with Western medicine. CEWM includes 4 clinics in Los Angeles county, providing ∼25 000 patient visits per year by a clinical team comprised 8.75 FTE faculty, 3 fellows, and 12 clinical specialists (LAc, CMTs). Patients are primarily referred from >500 primary care providers and specialists from within UCLA Health for a variety of refractory conditions (eg, fibromyalgia, irritable bowel syndrome, chronic headaches). CEWM utilizes a consultative clinical model based on a biopsychosocial framework that incorporates aspects of person-centered medicine, TCM, IM, generalist problem-solving, and interprofessional teamwork. Patients are seen by physicians with fellowship training in East-West Medicine and our clinical specialist team. Revenue is generated primarily through insurance reimbursement. The clinical program added a primary care arm in 2013 and will launch an inpatient consult service this year. There is a variety of educational programs including a visiting scholar exchange program with China, medical student electives, resident rotations, and an advanced-physician American Board of Integrative Medicine -recognized fellowship. This session will provide an in-depth view of the CEWM clinical model. We will use patient cases to guide participants through a typical patient experience at CEWM. Our management team will discuss the financial model, including experiences with expanding the program and suggestions for other clinics. We will present curricular examples from our international, fellowship, and medical student educational programs. Rationale: This topic is important given the current challenging insurance environment and recent closure of many IM ambulatory clinics nationally. CEWM has survived 24 years, and other IM center leaders may benefit from learning from our experiences, challenges, and triumphs during this time. CEWM is also an unconventional IM clinic with emphasis on integrating a single alternative health system as its core mission, and this model may be useful for other programs looking to start IM programs. CEWM is a strong example of “collaboration in action” through its consultative care clinical model, growing East-West primary care program, new inpatient program, and international exchange program with China. CEWM clinic visits include a customized treatment plan that involves collaboration between patient, physician, and clinical specialist (comprised TCM practitioners and integrative manual therapists). For example, patients see the clinical specialist and then their physician consultant at each follow-up visits to coprogress their care plan. Physicians and clinical specialists are “bilingually” trained in discussing patient care conditions in TCM and Western medicine nomenclatures and care philosophies. Each practice according to their own expertise and work together to comanage the patients care as a team. Treatment plans often include a variety of simultaneous therapies that may include acupuncture, cupping, tui na, myofascial release, and trigger point injections. Patients are actively engaged to create a self-care plan that might include integrative East-West nutritional guidance (based on modern nutritional and TCM diagnostic recommendations), flexibility and postural exercises, acupressure and self-massage, medication risk reduction guidance, and pertinent referral to various therapies (aquatic and land physical and occupational therapy, sleep medicine, weight loss management, mindfulness training) both at UCLA and in the local community. CEWM is expanding further to encourage collaboration and integration in the UCLA Health system. The East-West Primary Care program was created in 2013 for patients seeking care from more open-minded integrative generalists (who are also CEWM consultants part time) and to have access to the consultative clinic and care philosophy. This creates a fluid collaborative environment between our primary care and consultative treating clinical specialists. The East-West Inpatient Consult service will formally launch in 2018 and allow full-time East-West hospitalists to collaborate with inpatient medical providers to help patients with challenging symptoms and potentially reduce hospital length of stay. Finally, CEWM is leading the way to foster an exchange of expertise between IM in the United States and China. CEWM hosts visiting scholars and cohorts of health professionals from China to be immersed in our educational and clinical programs and to share their expertise and research with our Center’s staff and faculty. This cultural and knowledge exchange is the heart of our clinical fellowship and health trainee educational programs. For example, a fellow will be taught by a TCM expert, with a PhD and LAc degrees, as well as an integrative East-West faculty at the same session. Objectives: The aim is to learn about an integrative medicine clinical delivery model that is ∼25 years old and deeply ingrained into the culture of an academic health system; consider the integration of a specific alternative medicine system with Western medicine as an alternative to other integrative medicine “quarterback” models; identify the potential of incorporating trigger point injections and myofascial release with TCM therapies such as acupuncture, cupping, and tui na; experience examples of TCM inspired self-care techniques, including self-acupressure, that are taught to patients in our clinic; recognize how the model is financially sustainable and incorporates insurance payments to achieve this state; and identify the challenges and triumphs in growing an integrative medicine program within an academic health system. Outline: • Introduction to CEWM and the care delivery model (25 min).  ○ Clinic history with emphasis on the development from idea to creation of the clinic. • Key allies who supported the clinic and pivotal lessons learned during its growth.  ○ Ambulatory case-based learning examples.  ○ Visual presentation of a patient’s experience at clinic including the health history questionnaire, clinic environment, treatment experience, and self-care homework examples.  ○ Examples of EMR integration (including eg, Epic health system acupoint quick tabs).  ○ Self-care example with the audience: self-acupressure for common conditions and presentation of other patient handouts.  ○ Examples from our clinic to emphasize the role of a supportive workplace culture that values interprofessional teamwork. • Business and financial operation (15 min).  ○ Experiences with insurance and billing in the ambulatory setting for IM care.  ○ Experiences with coverage for different IM treatments and visit types.  ○ Tools to optimize length of visits. • Experiences with creating an integrative East-West primary care home within an established consultative care clinic (10 min). • Experiences developing collaborative local and international educational programs and curriculum (10 min). • Take away points and open question and answer session (10–15 min). (2259) Mindfulness-oriented Approaches to Pain and Opioid Misuse: Mechanistic Considerations and Clinical Applications Eric L Garland, PhD, LCSW1, Fadel Zeidan, PhD2 and David Vago, PhD3 1Center on Mindfulness and Integrative Health Intervention Development, Salt Lake City, Utah 2Center for Integrative Medicine, Winston-Salem, North Carolina 3Osher Center for Integrative Medicine, Nashville, Tennessee Abstract Overview: The development, testing, and validation of nonpharmacological approaches to treat pain are critically important today, as the national epidemic of opioid use and misuse has led to adverse clinical outcomes and failure in symptom management. Mindfulness meditation and other integrative health modalities have been found to significantly reduce pain in both experimental and clinical settings, with additional possible therapeutic benefit for opioid-related outcomes. Yet neither the mechanisms nor the appropriate prescriptive protocols remain clear in scaling treatment of heterogeneous populations of patients with acute and chronic pain seeking a narcotic-free, self-facilitated form of pain therapy. Here, we discuss the extant literature identifying the mechanisms of action that provide preliminary evidence for the utility of mindfulness-based modalities in attenuating pain and opioid misuse practices. We will delineate the prospects of its use in integrative health-care settings in an audience-integrated discussion. Rationale: There has been a need to develop and identify low-cost, noninvasive, and nonaddictive alternatives to opiates for the treatment of chronic pain. Mindfulness and other mind–body interventions have shown great promise in subserving this clinical population. In fact, in early 2017, the American College of Physicians developed a guideline providing evidence and clinical recommendations to use such integrative mind–body methods for first-line treatment of low back pain. Yet it remains unclear what aspects of pain are affected, which populations (eg, low back pain) are best served, which interventions are most effective, and the biological and physiological mechanisms by which such mind–body interventions may predict clinical outcomes. This proposed symposium is in alignment with the theme of the 2018 International Congress on Integrative Medicine and health—specifically to advance integrative health through the discussion of extant research in this field with experts studying and implementing such modalities in both controlled research and in clinical contexts that focus on pragmatic clinical trials and implementation science. Objectives: As a result of this session, participants will be able to understand the current literature on the effects of mindfulness on acute and chronic pain, examine in detail the underlying physiological and neurobiological mechanisms by which mindfulness and other mind–body health practices support clinical outcomes for experience of pain, and investigate best research and clinical practices as well as a prescriptive agenda for future research Outline: • Pain is a multidimensional experience that involves sensory, cognitive, and affective factors. The constellation of interactions between these factors renders the treatment of chronic pain challenging and often a financial burden. • Recent studies that demonstrate that mindfulness meditation significantly attenuates pain- and opioid-related problems through multiple, unique mechanisms. • Implementation of mindfulness in an integrative medical model can have various forms, and research has yet to demonstrate which treatment modalities are most effective for specific forms of chronic pain. • Best practices for research and pragmatic applications in integrative health care will be discussed. (3233) Integrative Oncology: International Perspectives Suzaane Grant, PhD, MPS, BAppSc, BA1, Elio G Rossi, MD2, Jennifer Hunter, PhD, MScPH, BMed3, Dugald Seely, ND. MSc4 and Jun J Mao, MD, MSCE5 1University of Western Sydney, Sydney, Australia 2Local Health Unit Tuscany North West, Region of Tuscany, Lucca, Italy 3Western Sydney University, Sydney, Australia 4Ottawa Integrative Cancer Centre, Ottawa, Ontario, Canada 5Memorial Sloan Kettering, New York, New York Abstract Overview: Integrative oncology (IO) is a new evidence-based specialty that integrates traditional and complementary medicine with conventional cancer care. IO acknowledges the increasing role that cancer survivors have in managing their own care, and the importance of a therapeutic alliance that respects the preferences and values of cancer survivors. Increasingly, IO services are being provided by public and private health sectors across the globe. Often however, service development is ad hoc and fragmented, reflecting local factors rather than coordinated regional or national planning and policy. In this symposium, leading health-care professionals and researchers from 3 continents (North America, Western Europe and Australia) will present an overview of the extent of IO service provision and its implications for clinical practice, health service delivery, education and research. Financial, informational, cultural and logistical barriers and solutions will be discussed from the perspectives cancer survivors, health-care professionals, organizations and policy makers. Rationale: This symposium will bring together leading health-care professionals and researchers from across the globe to discuss the development of integrative oncology services and its implications for clinical practice, health service delivery, education, research and policy. Objectives: The aim is to disseminate experience and knowledge from the different countries and continents to identify mutual trends and future directions for IO service provision; gain insight into unmet needs and facilitators and barriers for IO and obtain knowledge about organizational and educational aspects, strategies and policies to support the appropriate development of IO services. Outline: 1. IO in North America, Western Europe and Australia. 2. Current practices, models and policies for IO services in the respective continents and countries. 3. Important unmet needs and barriers/facilitators for implementation of IO. (3264) Effectiveness of a Self-care Tool Kit for Surgical Breast Cancer Patients in a Military Treatment Facility Dawn M Bellanti, MSN, FNP1, Erika Stoerkel, MPH, TLIF2, Kimberly Peacock, EdD3, Alice Inman, PhD4 and Robert Setlik, MD4 1MedStar Institute for Innovation, Kensington, Maryland 2McLean, Virginia 3University of Texas Health Sciences Center San Antonio, San Antonio, Texas 4San Antonio Military Medical Center, Fort Sam Houston, Texas Abstract Purpose: To assess whether a self-care tool kit (SCT) provided to newly diagnosed breast cancer patients undergoing surgery could mitigate distress and lessen symptoms associated with surgery and anesthesia. Results: There were significant between group differences from baseline to follow-up in PROMIS-57 scores of Pain interference, Fatigue, and Satisfaction with social roles, favoring the SCT group compared to TAU (P = .005, P = .023, and P = .021, respectively). There was a significant mean change in DVPRS scores from T2 to T3, with the SCT group having significantly smaller increases in postoperative pain (P = .008) and in postoperative ESR (P = .0197) compared with the TAU group. Clinically, significant reductions in anxiety occurred in the SCT group during the main intervention period. Conclusions: These results suggest that using the SCT in the perioperative period decreased pain perceptions, fatigue, and inflammatory cytokine secretion. (3285) Spirituality and Health: The Science of Connection and Meaning and Why This Matters Tobi Fishel, PhD1 1Residency Wellness Abstract Overview: Spirituality has been a controversial and significant aspect of health and healing. Within the arena of integrative medicine, holistic health as described as addressing mind, body, and spirit, but much less attention has been paid to the latter, even though there is a robust literature outlining the benefits of exploring spirituality and its connection to one’s illness, and that having spiritual practices can provide protective mechanisms for health and well-being. In addition, with clinician (particularly physician) burnout and depression being recognized as an epidemic in the United States, many solutions are focused on returning the clinician’s focus to meaning in medicine, very much connected to the spirituality of health and healing. This workshop will examine the latest research on spirituality and health, spirituality and compassion, and spiritualty and meaning making for patients and clinicians alike. Experiential practices that can be used for clinician self-care as well as for patients’ well-being will be offered. Rationale: Much research has demonstrated significant benefits in health outcomes by engaging in spiritual practices. However, this area in often minimized and even neglected in the clinical encounter. In this workshop, participants will be introduced to the research showing health benefits for patients as well as learn practical ways to introduce this concept and ways to incorporate practices into the encounter (eg, compassion meditation, rituals, ceremony, meaning making). Objectives: Participants will be able to identify current research in the area of spirituality and health. Participants will explore the connection between spirituality, connection, depression, illness, and compassion. Participants will learn and practice 3 exercises that can be used for patients and clinicians for health benefits (ie, gratitude, compassion, ritual). Outline: Definitions—spirituality versus religion Research on spirituality and health—less anxiety, more ease, and better coping with chronic illness, experience more meaning in illness, longer life, less depression, and less burnout for clinicians Exploration of connection between spirituality and compassion Experiential practices—gratitude, compassion meditation, ritual/ceremony Review of a case (3305) Yoga in the Occupational Setting: Efficacy Research Studies Sat Bir S Khalsa, PhD1, Maryanna D Klatt, PhD2 and Crystal L Park, PhD3 1Brigham and Women’s Hospital, Boston, Massachusetts 2College of Medicine, The Ohio State University, Columbus, Ohio 3Storrs, Connecticut Abstract Overview: Chronic occupational stress is highly prevalent in the workplace and negatively impacts many aspects of psychological and physical health, including decreased immune function and increased risk of disease and mortality. Stress is also a main contributing factor to workplace absenteeism, employee turnover, job satisfaction and performance, and loss of productivity. It is important to identify and evaluate interventions that can provide practical skills and techniques to regulate stress, foster resilience, improve positive affect, reduce negative affect, increase empowerment and self-efficacy, increase and/or maintain healthy behaviors such as physical exercise and a healthy diet, and improve quality of life, wellness, and well-being. Preliminary studies of resilience-training programs, some of which include aspects of mindfulness, compassion, self-regulation of stress, and cognitive behavioral techniques, have been shown to improve psychological and physical well-being and job performance. Mind–body interventions such as yoga are accessible, highly adaptable, practical approaches that can build resilience to stress. Yoga is a comprehensive multicomponent practice including postures and physical exercises, breath regulation techniques, deep relaxation, and meditation and mindfulness practices. The scientific evidence for the psychological and physical health benefits of yoga continues to accumulate and the use of yoga in the United States is on the rise, with approximately 10% of U.S. adults having practiced yoga in 2012, and it is therefore a potentially useful and attractive workplace intervention. This symposium will present findings from 3 investigators who have conducted research on the implementation of yoga programs in occupational settings. Rationale: Stress in the occupational/workplace setting is a growing concern, with over 70% of working people reporting that their occupation is a main source of stress. Chronic occupational stress negatively impacts many aspects of psychological and physical health, including decreased immune function and increased risk of disease and mortality. Stress is also a main contributing factor to workplace absenteeism and loss of productivity, with 60% of workers reporting loss of productivity due to stress over the previous month and an estimated 1 million workers in the United States are absent each day due to stress. Workplace interventions that can provide practical skills and techniques to regulate stress to prevent psychological and physical health problems are therefore important. Resilience is a positive adaptation to otherwise stressful situations whereby mental health is maintained or recovered despite experiencing adversity. Fostering resilience can help reduce stress, improve positive affect, reduce negative affect, increase a sense of empowerment or self-efficacy, and increase or maintain healthy behaviors such as physical exercise and a healthy diet. In occupational populations, higher resilience is associated with higher job satisfaction and workplace happiness. Indeed, resilience-training programs, some of which include aspects of mindfulness, compassion, self-regulation of stress, and cognitive behavioral techniques, have been shown to improve psychological and physical well-being and job performance. Practical and cost-effective techniques that increase resilience may benefit organizations by saving costs related to loss of productivity and absenteeism. Mind–body interventions such as mindfulness-based stress reduction (MBSR) and yoga are accessible, highly adaptable, practical approaches that can build resilience to stress. The scientific evidence for the psychological and physical health benefits of mindfulness and yoga continues to accumulate and the use of yoga in the United States is on the rise, with approximately 10% of U.S. adults having practiced yoga in 2012. Recent reviews and meta-analyses of mind–body interventions in professional populations have shown improvements in stress, resilience, mindfulness, and affect. A meta-analysis of 19 studies indicated that brief (eg, 4 weeks) mindfulness interventions were as effective as longer (eg, 8 weeks) interventions for improving psychological health, including stress, affect, mood, anxiety, depression, job satisfaction, and sleep quality. Therefore, programs that teach mindfulness practices over a shorter period of time may be more practical and cost-effective approach to organizational programs. Importantly, recent evidence suggests that the yoga component of MBSR may be the critical element necessary for improving psychological wellbeing—even more than the mindfulness meditation or body scan components. Yoga is a multicomponent system of mind–body practices including physical postures and exercises, breathing exercises, deep relaxation techniques, and meditation/mindfulness practices. Systematic research reviews support the use of yoga for promoting psychological health. There is burgeoning evidence that yoga is effective for promoting psychological health in occupational settings. Objectives: Participants will understand the need for behavioral interventions in occupational settings and the rationale for yoga as a practical efficacious intervention in the workplace. Participants will understand the yoga intervention characteristics that have been used in research evaluating the benefits of yoga interventions in the workplace setting. Participants will understand the efficacy of yoga on physical and mental health and performance on a variety of outcome measures in multiple research studies. Outline: • Introduction to the symposium topic and the speakers • The psychological and health challenges in the occupational setting and the rationale for yoga as a workplace intervention • Introduction to yoga practice and a logic model for the efficacy of yoga in health and wellness in the workplace • Brief review of prior research on mind–body interventions in workplace settings • Presentation of research on yoga in mental health-care providers by Crystal Park • Presentation of research on yoga in workers in high-stress health-care environments by Maryanna Klatt • Presentation of research on yoga in clerical, enforcement, education, and health-care workers by Sat Bir Khalsa • Question and answer panel with symposium attendees and all 3 faculty. (3307) Anti-inflammatory Diet in Pediatrics: From Evidence to Practice Maria Mascarenhas, MBBS, Hiliary McClaferty, MD1 and Diane L Barsky, MD2 1Tucson, Arizona 2Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Abstract Overview: The role of nutrition in health promotion, disease prevention and treatment is being increasingly recognized. Persistent inflammation is linked to the development of chronic disease. Data from several large international studies have illustrated the many health benefits of the Mediterranean and Asian diets. The anti-inflammatory diet (AI) which combines these 2 diets is an evidence-based diet that can be used to decrease inflammation, improve health and prevent chronic disease. It encompasses not just nutrition but a lifestyle approach which includes physical activity, whole foods approach, food preparation, community and farm-to-table concept. Rationale: Inflammation is a natural way the body reacts to protect and assist in the healing process. At times, the inflammatory response can persist, contributing to or leading to the development of chronic diseases. The AI diet when followed regularly may decrease the inflammatory response and decrease the risk of obesity, type 2 diabetes, heart disease and other-associated chronic diseases. The emphasis of the diet is to maintain and/or improve health through nutrition and lifestyle changes. The AI diet can be a part of a broad approach to treat chronic disease linked to inflammation. The focus is not on nutrition instead of medicine, but “Nutrition as Part of Medicine”! This symposium will present a brief history of the diet and summary of research in adults and pediatrics. The pediatric AI pyramid will be discussed in detail including its development and implementation in clinical practice. As the conference focuses on advancing integrative health through research, education, clinical practice and policy, we plan to educate participants on the research, education and clinical practice can be used to improve the health of children through nutrition. Objectives: The aim is to be knowledgeable about the history, benefits and components of the AI diet; be aware of the research demonstrating the benefits of the AI diet and be able to implement the AI diet in care of pediatric patients. Outline: AI Diet in Pediatrics Background History of the development of the AI diet, components, how it blends the Mediterranean and Asian diets, whole foods approach and lifestyle changes including physical activity and mindful eating Review of the health benefits Research Review of the adult and pediatric literature supporting the use of the AI diet with respect to cardiovascular risk, obesity, diabetes, non-alcoholic fatty liver disease, asthma/allergies and microbiome Implementation Presentation of the pediatric AI diet pyramid Discussion of practical aspects of the AI diet in pediatric practice and available resources (3313) Reduced Interference in Working Memory Following Mindfulness Training Is Associated With Increases in Hippocampal Volume Sara W Lazar, PhD1, Jonathan Greenberg, PhD1, Victoria L Romero, PhD2, Seth Elkin-Frankston, PhD2, Matthew A Bezdek, PhD3 and Eric H Schumacher, PhD3 1Massachusetts General Hospital, Boston, Massachusetts 2Charles River Analytics, Cambridge, Massachusetts 3Georgia Institute of Technology, Atlanta, Georgia Abstract Purpose: Proactive interference occurs when previously relevant information interferes with retaining newer material. Overcoming proactive interference has been linked to the hippocampus and deemed critical for cognitive functioning. However, little is known about how this ability can be improved or about the neural correlates of such improvement. Mindfulness training emphasizes focusing on the present moment and minimizing distraction from competing thoughts and memories. It improves working memory and increases hippocampal density. The current study examined whether mindfulness training reduces proactive interference in working memory and whether such improvements are associated with changes in hippocampal volume. Results: The mindfulness group exhibited significantly greater accuracy in proactive interference resolution compared to the active control group following training, and these memory improvements were significantly associated with volume increases in the left hippocampus. Conclusions: Results provide the first evidence suggesting that mindfulness training can protect against proactive interference and that these benefits are related to volumetric increases in the left hippocampus. In light of these results, it is suggested that mindfulness may be particularly beneficial for individuals with conditions typically characterized by impairments to working memory and reduced hippocampal volume such as depression, childhood adversity, post-traumatic stress disorder, and aging. (3320) Can Acupuncture Be an Opioid-sparing Treatment for Chronic Pain Management? Lucy Chen, MD, MGH1 and Jianren Mao, MD, PhD1 1Boston, Massachusetts Abstract Overview: Opioids are often used to treat moderate to severe cancer-related pain. In recent years, there has been a dramatic increase in opioid use for the treatment of chronic, noncancer-related pain conditions despite riskes and lack of clear evidence of its effectiveness. Based on the Centers for Disease Control and Prevention report, nearly 2 million Americans were dependent on prescription opioids for pain relief in 2014 alone. Deaths from opioid overdose have more than quadrupled since 1999. Accordingly, nonpharmacologic therapies and nonopioid pharmacological therapies are perferred for chronic pain management. Various modalities of complementary and alternative medicine, particularly acupunture, have been used in acute and chronic pain management. Indeed, acupuncture could become a useful adjunctive therapy for chronic pain management to reduce the opioid use. However, the pressing issue is to understand the role of acupuncture in chronic pain control and to explore innovative assessment tools for the effectiveness. The objective of this symposium is to provide (1) information about current opioid-related issues in pain management, (2) data from current clinical trials on the role of acupuncture therapy in pain management, and (3) current research on innovative assessment tools for evaluation of acupuncture effectiveness. Rationale: Chronic pain affects more Americans than diabetes, heart disease, and cancer combined and is one of the most common causes for many patients to seek medical assistance. There has been a dramatic increase in opioid use in the treatment of chronic, noncancer-related pain conditions and deaths from opioid overdose have more than quadrupled over the last 2 decades. Despite new pain medications and advancement in interventional and surgical procedures for chronic pain management, nonopioid treatments are urgently needed in clinical practice. However, it remains unclear as to how effectively acupuncture can be used as an opioid-sparing tool for the management of chronic pain conditions with regard to clinical outcomes and assessment tools that should be used to analyze clinical outcomes. This symposium will address both of these issues and provide the up-to-date information from the literature as well as our own clinical studies. Dr Chen will serve as the moderator and a speaker. She will discuss current data on the effectiveness of acupunture therapy in pain management. Dr Mao will discuss the issues related to opioid use as well as innovative tools to assess acupuncture trials. Objectives: The aim is to understand the role of acupuncture thepray in pain management, provide research data on the efficacy of acupuncture therapy, and discuss innovative assessment tools for evaluation of acupuncture effectiveness. Outline: 1) Clinical efficacy of acupunture treatment; 2) Challenges in acupuncture trials for pain management; 3) Role of translational research in developing innovative assessment tools for evaluation of acupuncture effectiveness. (3333) Results From RAND/NCCIH Center of Excellence for Research on CAM: Patient-centered Methods for Determining the Appropriateness of Manipulation and Mobilization for Chronic Neck and Low Back Pain Ron D Hays, PhD1, Lara G Hilton, MPH2, Gery Ryan, PhD2, Ian D Coulter, PhD2 and Patricia M Herman, ND, PhD2 1UCLA, Los Angeles, California 2RAND Corporation, Santa Monica, California Abstract Overview: This symposium provides the results of the 4-year RAND/NCCIH Center of Excellence for Research on CAM (1U19AT007912-01). The Center includes 4 projects and an ancillary R21 study examining the appropriateness of 1 form of complementary and integrative health (CIH) care. The studies focus on chiropractic manipulation/mobilization for chronic low back and cervical pain, but the methods are applicable to other therapies and conditions. We used the traditional method of determining treatment appropriateness with the RAND/UCLA expert panel process using evidence and clinical experience of effectiveness and safety, but extended it by incorporating patient preferences, resource utilization, and patient-reported outcomes into the determination of the appropriateness with data collected from 2024 patients sampled from 125 chiropractic clinics from throughout the United States. The panels were asked to rerate appropriateness after considering these new data inputs to determine whether their appropriateness ratings changed. The definition of appropriateness was expanded to match the needs of CIH where patient preferences are expressed in self-referral and out-of-pocket payments are common, and, thus, patient preferences and costs can also be important in the determination of appropriate care. An ancillary study examined whether crowdsourced data could be used as an efficient and effective patient data collection method in future studies. This symposium will provide a brief overview of the organization of the Center, followed by results from each of the projects and culminating in the key findings from the expert panels after they had been asked to consider patient-reported preferences and costs in their new appropriateness ratings. Project-specific results include national data on outcomes including patient experiences with care, health-related quality of life, and patient preferences, and economic simulation models of the relative cost-effectiveness of nonsurgical interventions for chronic low back and neck pain. Rationale: The appropriateness methodology provides what is known from research to experienced clinicians who translate the evidence into practice considering the range of patient presentations in real-world clinical practice. Understanding the appropriateness of care is essential to improve clinical outcomes, determine the need for guidelines, and inform policy. If most of the care provided is judged to be appropriate, then no changes to clinical guidelines are needed. If a substantial amount of care is judged to be inappropriate or indeterminate, then policies to improve practice or more research are needed, respectively. The addition of patient preferences, resource utilization, and patient-centered outcomes to the traditional appropriateness methods is essential for complementary and integrative health policy and health care in general. Objectives: The aim is to articulate the traditional procedure for assessing the appropriateness of care and the use of these ratings in health policy; report on the appropriateness of manipulation and mobilization in a large representative sample of U.S. chronic low back and neck pain patients when only effectiveness and safety are considered; identify elements of patient preferences, outcomes, and resource utilization that should be included, along with effectiveness and safety, in the determination of care appropriateness; and report on the appropriateness of manipulation and mobilization in our sample when patient preferences, resource utilization, and patient-reported outcomes are considered. Outline: • Overview of the center, introduction to appropriateness method, and findings from the appropriateness panels when only effectiveness and safety are considered (Ian D Coulter, PhD) • Results of psychometric testing of PROMIS and CAHPS on this population and the relationship of these outcomes to the appropriateness of care (Ron Hays, PhD) • Findings from surveys on patient preferences, satisfaction, expectations, coping behaviors, and pain profiles which may affect the ratings of appropriateness (Gery Ryan, PhD). • Results of the economic simulation models on the relative cost-effectiveness of alternative interventions which may affect the ratings of appropriateness (Patricia Herman, ND, PhD). • Results from using crowdsourcing as an alternative data collection method for clinical research (Lara Hilton, MPH). • Changes seen in the ratings of the appropriateness of manipulation and mobilization after patient-centered data are introduced (Ian D Coulter, PhD). • Discussion (Lead by Ian Coulter). (3367) Cognitive Impairment and Alzheimer’s Disease: Integrative Approaches to Prevention and Treatment George C Wang, MD, PhD1 and Mikhail Kogan, MD1 1Washington, DC Abstract Overview: Dementia is one of the greatest health care and social challenges in the 21st century. Alzheimer’s disease, accounting for 60%–80% of dementia cases, affects more than 4 people in the United States and nearly 44 million globally. Current pharmacologic treatments do not halt or reverse the progression of dementia. In this session, we will first discuss the state of the science in understanding the pathogenetic mechanisms of cognitive impairment and Alzheimer’s disease and risk factors for developing dementia. We will present a whole-person framework for understanding the complex mix of etiologies and perpetuating factors that underlie the temporal spectrum encompassing cognitive impairment and dementia. Through this framework, we will discuss integrative approaches to prevention and treatment. Case examples will illustrate the use of a systematic approach to successfully halt or reverse the progression of dementia. The session will conclude with an expert panel and interactive questions and answers with the audience. Three faculty presenters, comprising geriatricians and integrative medicine physicians from Johns Hopkins University and George Washington University with research and clinical expertise in the field, will foster an appreciation of the important roles that integrative health practitioners can play in addressing the global dementia challenge through prevention and whole-person therapeutic plans. Rationale: Dementia is one of the greatest health care and social challenges in the 21st century. Alzheimer’s disease is responsible for 60%–80% of cases of dementia. The estimated number of people with Alzheimer’s disease is more than 4 million in the United States and nearly 44 million worldwide. These numbers are projected to triple by 2050. The annual cost of dementia care is estimated to be $150–$215 billion in the United States and $600 billion globally. The annual direct cost of dementia care has already exceeded those for heart disease and cancer. Currently available pharmaceutical treatments do not address the underlying pathology and do not halt or reverse the progression of cognitive impairment in Alzheimer’s disease. Understanding Alzheimer’s disease through the pathophysiologic lens of amyloid beta protein and tau protein has not led to a successful therapeutic agent in humans. In fact, cognitive impairment and Alzheimer’s disease comprise a complex mix of etiologies and perpetuating factors and represent a temporal spectrum of pathological progression with opportunities for intervention and varying potential for reversal across time points. A whole-person approach is required for optimal treatment. Objectives: The aim is to recall mechanisms of pathogenesis in cognitive impairment and Alzheimer’s disease; recognize risk factors for developing cognitive impairment and dementia; discuss integrative approaches to prevention of cognitive impairment and dementia; and outline a whole-person functional approach to the care, treatment, and reversal of cognitive impairment and Alzheimer’s disease Outline: The session will be organized into 2 presentations and an interactive panel: 1) Cognitive impairment and Alzheimer’s disease: pathogenesis and integrative approaches to prevention We will present the state of the science in the current understanding of the pathogenesis of cognitive impairment and Alzheimer’s disease. We will provide a brief history of the development of amyloid beta and tau protein hypothesis and biologic/pharmacologic interventions that have been developed. We will discuss the epidemiology of cognitive impairment and dementia. Data from population studies that have identified risk factors for dementia will be summarized. We will present a whole-person framework for conceptualizing the pathogenesis of cognitive impairment and dementia and discuss integrative approaches to prevention. This framework serves as a crucial foundation for understanding the critical roles that primary care and integrative health practitioners can play in addressing the global challenge of dementia in the decades to come. 2) Whole-person approach to the care and treatment of persons with cognitive impairment and Alzheimer’s disease: rationale and case examples Cognitive impairment and Alzheimer’s disease comprise a complex mix of etiologies and perpetuating factors and represent a temporal spectrum of pathological progression with opportunities for intervention and varying potential for reversal across time points. A systematic, whole-person, functional approach is important in making the proper diagnosis and formulating an effective treatment plan. We will outline the rationale for such a whole-person approach and will outline a systematic approach to uncovering the etiologies and perpetuating factors in these persons. We will review Dr Dale Bredesen’s work, including his 2014 and 2016 case series of 10 patients who had reversal of Alzheimer’s disease. Dr Kogan will present a number of case examples from the GW memory clinic documenting reversal or arrest of Alzheimer’s disease progression. Additionally, we will present a framework for engaging the public, funding agencies, and academia in advancing the understanding and clinical practice of this treatment approach. (3369) Medical Fasting—State of the Art John S Finnell, ND, MPH, Lac1, Rainer- Stange, PhD2, Sebastian Brandhorst, PhD3 and Valter Longo, PhD4 1Bastyr University Research Institute, Austin, Texas 2Charité - Universitätsmedizin Berlin and Immanuel Hospital, Berlin, Germany 3Los Angeles, California 4FIRC Institute of Molecular Oncology, Los Angeles, California Abstract Overview: There exists a historical precedence for the use of various fasting modalities for both medical and religious purposes, which are held in common across many cultures. Well-characterized protocols for medically supervised fasting for specific indications emerged in the United States and in Europe within the 19th and 20th centuries, respectively. To date, however, there has been limited evidence supporting the efficacy and safety of these modalities. It is estimated that clinics in Europe and the United States specializing in medically supervised fasting protocols treat approximately 100 000 patients with fasting each year. The predominant indications for fasting reported in the literature include metabolic disorders, hypertension, rheumatism, and other pain conditions and have recently expanded to include indications, such as cancer, neurodegenerative diseases, as well as the evaluation of novel protocols of time-restricted feeding and intermittent fasting. The interest in research on fasting protocols has increased, as the need for novel approaches to treat chronic degenerative diseases has grown. Fasting in different modalities has been common to many cultures and religions for centuries. Medically indicated, supervised, and evaluated fasting, however, has emerged within the 19th century in the United States and the 20th in several European countries and been given a limited amount of evidence as toward efficacy and safety so far. Some clinics in Europe and the United States are specialized treating approximately 100 000 patients with fasting each year. Predominant indications are metabolic disorders, hypertension, rheumatism, and other pain conditions. Within recent decades, there has been further support by preclinical research, pointing to further indications like cancer and neurodegenerative diseases, and evaluating new patterns of time-restricted feeding or intermittent fasting. Rationale: Medically supervised fasting is a growing integrative medicine modality that is being studied internationally. It is therefore necessary to characterize the evidence presented to date, describe best practices, and establish the further research needs in this emerging field of study. Medically supervised fasting is already, resp. will be a growing part of integrative medicine everywhere. It therefore seems necessary to outline the scientific results given so far and directions of further research as well as good practice. Objectives: The aim is to outline the standard practices of medically supervised fasting protocols, including the patient assessment and examination, contraindications and safety, and relevant outcome parameters. Develop standard guidelines for counseling about self-practice of time-restricted feeding and intermittent fasting and to outline of practice of medical fasting including contraindications, safety exams, and outcome parameters. Counselling about self-practice of time-restricted feeding, resp. intermittent fasting. Outline: Valter Longo, Sebastian Brandhorst: Most important results of preclinical research including neurodegenerative and oncological diseases as well as first trials of time-restricted feeding with healthy humans. John Finnell: Practice of fasting and results of research on safety Rainer Stange: Acceptance, clinical evidence by uncontrolled and controlled clinical trials with long-term (>5 days) fasting, projects of present and future research. Outline of certified qualifications for MDs in Austria and Germany. Clinical evidence of fasting and oncological chemotherapy by so far 3 randomized controlled trials. (3381) Mindful Resilience: An Innovative Honors Course Addressing Individual/Organizational Resilience via the Embodiment of Integrative Health Practices Maryanna D Klatt, PhD1 1College of Medicine, The Ohio State University, Columbus, Ohio Abstract Overview: Emerging contemplative education courses and academic programs that focus on embodying integrative health (IH) have a unique opportunity to help students gain both self-awareness and an awareness of the pragmatic benefits of IH in their life and career. Research utilizing meditation in higher education shows promise in building resilience, interpersonal skills, and the cognitive capabilities of attentional control. Pragmatic, reflective pedagogy that successfully cultivates personal and social awareness is an avenue to give our future health-care professionals the tools and capacity to create institutions that are built to facilitate both individual and organizational resilience. Course content and structure of Mindful Resilience: From the Individual to the Organization will be shared so that others can utilize this curricular innovation to teach resiliency skills to preprofessionals. The course was informed by the recognition of the necessary quadruple aim, “care of the provider” as pivotal to delivering quality patient-centered care, and was designed to equip preprofessionals with the IH skills/practices to preempt burnout and compassion fatigue, requiring a self-care program by course completion. The course utilizes guided mindfulness meditation and reflective writing to help students reflect upon their ‘‘performance of self’’ to increase awareness and help sculpt their personal and professional lives. Interprofessional guest speakers share resiliency narratives and are intentionally timed with specific scholarly readings. This pedagogy demonstrates an innovative and creative application of the theory of contemplative practice in action with the goal of creating a more nurturing culture in which we live and work. Students recognize by semester end the absolute necessity of being proactive about one’s self-care in order to adequately care for ones patients. The earlier a student is made aware of the existing challenges encountered by health-care practitioners, the sooner they may be open to developing wellness practices, strategies, and organizational structures to sustain them. Rationale: This topic is critically important, as we need share curriculum to teach emerging professionals the huge contribution that IH can make in their life and careers. Curricula that are designed to give students a first-person experience of meditation, reflection, and mindful movement while they are preprofessionals is invaluable so that they can enjoy the lifelong benefits that IH affords. This curricular innovation has been featured in 2 journals, Medical Teacher and the Journal of Transformative Education, and embodies a curricular advance in teaching the usefulness, and value, of IH. Objectives: Participants attending this session will learn about the curricular elements that have successfully been employed in teaching emerging health-care professionals, the benefit of IH practices for their own life and work, discern which curricular pieces and parts may be most vital in teaching future health-care professionals about the value of IH, and be able to design similar curricular innovations at their home universities based upon this successful model. (3384) Evidence-based Nonpharmacologic Pain Medicine as Culture Change in Practice, Education, and Policy: How Do We Get There From Here? Samantha Simmons, MPH1, Rosanne Sheinberg, MD1, Arya Nielsen, PhD1, Rebecca Schultz, MS1 and Heather Tick, MD1 1Seattle, Washington Abstract Overview: Medical pain management is in crisis. The United States leads in the epidemic of opioid overuse, abuse, addiction, and death, but the failure to adequately treat pain and the adverse effects of conventional pain treatments are a worldwide challenge. The National Academy of Medicine (formerly IOM), National Institutes of Health National Pain Strategy, Veterans Health Administration, Department of Defense, the Federal Food and Drug Administration, Centers for Disease Control and Prevention, National Institute for Drug Abuse, and the Joint Commission (TJC) have all called for increased use of evidence-based nonpharmacologic care. Moreover, these effective and low-risk strategies should be engaged early in the course of care instead of as a last resort when all else has failed. The ACIMH is well positioned to present the evidence base for nonpharmacologic options, outline best practices, facilitate the development of teaching curricula, and inform policy decisions to create a culture change in pain medicine and ultimately health care. Rationale: Why the topic is important and its relevance to the conference themes? It is widely acknowledged that medical pain management is in crisis: from the pervasiveness of pain to inadequate pain treatment, from the escalation of prescription opioids to an epidemic in addiction, diversion, and overdose deaths, the rising costs of pain care and managing adverse effects of that care have prompted action from state and federal agencies. The Consortium Pain Initiative was developed to address (inform) these issues with our unique combination of foundations in research, academic rigor, educational access, history of work with policy, and our mission to shift health care to be more person centered, effective, evidence based, and safe. Objectives: The aim is to discuss evidence-based nonpharmacologic strategies that are opioid sparing have been shown to reduce opioid need; describe which nonpharm therapies have been shown to be effective for acute postsurgical or trauma pain; describe which nonpharmacologic therapies have been shown to be effective for chronic pain not only reducing the risk of opioid use, but the illness behavior opioids produce; and understand current state and federal policies facilitating and inhibiting implementation and integration of nonpharm therapies for pain Outline: The Pain Project White Paper: introduction and the meaning of culture change in pain medicine. Thomas Kuhn outlined the steps that lead to culture change or paradigm shifts in science. Early adopters are significant catalysts in this process. This section will explore how work over nearly 2 decades has positioned the consortium to help effect these changes. How do we build the road map for lasting culture change in medicine using the current crisis in pain medicine, the unsustainable costs of health care, and the growing burden of disease as catalysts for change? (Heather Tick) Evidence: the White Paper (Arya Nielsen) 1. The Consortium Pain Task Force White Paper: Evidence-based Nonpharmacologic Strategies for Comprehensive Pain Care 2. Creating facile access to updates in evidence-based pain medicine 3. Dissemination strategies: learn to “recruit and represent” for a culture change in medicine by relying on evidence-informed best practice 4. Prepare for discourse and interview strategies when interacting with friendly, unfriendly, uinformed, or hostile questions Clinical Best Practice: The development of best practices in nonpharmacologic pain care (Rebecca Schultz) 1. Create evidence-informed clinical practice recommendations for pain conditions 2. Incorporate whole person assessments to determine recommendations 3. Encourage shared decisions making and partnering with patients to create a comprehensive pain plan that includes nonpharm options 4. Collaborate interprofessionally to enhance clinical knowledge and patient outcomes 5. Identify resources to support nonpharmacologic pain options Education: The development of educational curricula for nonpharmacologic pain care (Rosanne Sheinberg) 1. Audience we seek to educate 2. Creation of level playing field 3. Paradigm shift 4. Widening the tool box 5. Dissemination in educating target groups 6. Content to be covered Policy: How to effect policy shift: (Samantha Simmons) 1. This part of the session will focus on what attendees can do to help drive policy changes in their states, highlight resources available to them to assist their efforts, and describe how some states have been successful in implementing policies that aim to help patients with pain and reduce opioid dependence and misuse. (3388) Using Interactive Medicine Apps and Technologies for the Treatment of Health Conditions: A Hands-on Usability Workshop Paula Gardiner, MD, MPH1 and Robert Bonakdar, MD1 1San Diego, California Abstract Overview: There are thousands of different technologies available for patients to treat and manage their health conditions. Integrative medicine techniques (mindfulness, nutrition, and coaching) have become popular subjects for apps and technologies. This hands-on workshop gives the attendee a firsthand experience of technology (apps, devices, and Health Insurance Portability and Accountability Act compliant telehealth services) for the treatment and monitoring for health conditions including chronic pain and diabetes. There are many apps/devices available to patients, and our workshop will give an overview of how the evaluate the evidence, benefits, and risks of these technologies. Rationale: It is important for clinicians and researchers to be able to advise their patients on evidenced-based integrative medicine apps, devices, and telehealth services. Objectives: By the end of these sessions, participants will be able to list 3 components of what makes an evidence-based technology, explain the pros and cons of usability testing, and list 2 resources on where to find evidence reviews on technology. Outline: 1. Introduction to what types of technologies are available on the market and which have been tested. 2. Components of excellent patient technology and how to interpret the research. 3. Guidelines: How to perform usability testing on your technology. 4. Experiential stations:  ○ Station 1: Mindfulness apps  ○ Station 2: Nutrition/fitness apps  ○ Station 3: Coaching apps (3391) Research Recruitment Strategies for Undeserved Patients: Lessons Learned Paula Gardiner, MD, MPH1, Iniya Rajendran, MD1, Myles Spar, MD1, Robert B Saper, MD, MPH1 and Benjamin Kligler, MD, MPH1 1Bronx, New York Abstract Overview: Low-income racially diverse patients are a historically challenging population for research recruitment. Yet integrative medicine research is taking place in community health centers and safety net hospitals around the country. This panel will present several viewpoints about their recruitment strategies. Speakers include viewpoints from both a practice-based research network (PBRN) and representatives from 2 randomized controlled trials funded from Patient-Centered Outcomes Research Institute (PCORI). This panel will share methods and strategies in overcoming barriers related to recruitment of this patient population. Methods will include provider referral, warm handoffs (face-to-face encounters with a research assistant during a clinical session), targeted letters, and self-referral after seeing flyers, or using patient incentives such as gift cards. Our 3 sites with discuss our challenges and successes with recruitment methods and using patient incentives. Rationale: Low-income racially diverse patients are a challenging population for research recruitment. Yet integrative medicine research is taking place in community health centers and safety net hospitals around the country. We will represent 3 different institutions and different types of recruitment methods. Objectives: The aim is to list 3 strategies to recruit low-income racially diverse patients, describe to an IRB agent why these strategies are necessary and unique human subject’s protections, and identify existing low literacy resources available for recruitment on the Internet. Outline: 1. Introduction to the challenges working with low-income racially diverse patients 2. Discussion of recruitment strategies used in the PCORI-funded acupuncture approaches to decrease disparities in outcomes of pain treatment—A 2-arm comparative effectiveness trial 3. Discussion of recruitment strategies for BraveNet—PBRN 4. Discussion of recruitment strategies used in the PCORI-funded integrative medical group visit randomized controlled trial 5. Large group discussion and questions from audience (3395) Traditional, Complementary, Integrative, and “Articulated Medicine” at the Pan American Health Organization: Research Priorities and Partnerships John Weeks1, Daniel Gallego-Perez, MD2, Daniel Miele Amado, MD3, Ricardo Fabrega, MD, MPM4 and Tabatha Parker, ND5 1The Integrator Blog News & Reports, Seattle, Washington 2Pan American Health Organization/WHO, Medellin, Colombia 3Brazil Health Ministry, Sao Paulo, Brazil 4Pan American Health Organization/WHO, Washington, DC 5Natural Doctors International, Ometepe, Nicaragua Abstract Overview: Participants will explore the most significant integrative undertaking in the Western hemisphere: to create the skills, knowledge, collaborations, and partnerships that will optimize the role of traditional, complementary, and integrative health products, practices, and practitioners in meeting the goal of primary care for all. The goal is urged by the World Health Organization (WHO) 2014–2023 Traditional Medicine Strategic Plan and the Pan American Health Organization’s (PAHO) Strategy for Universal Access to Health and Universal Health Coverage (2014). National efforts throughout the Western hemisphere are presently being supported by PAHO’s technical cooperation and networked through a PAHO-facilitated effort, with the support of academic collaborations. This panel will provide perspectives from professionals who have been engaged in providing advice and leadership in developing PAHO and WHO strategies, as well as those others working inside various national health-care systems in the region, and supporting academic institutions, to achieve the goals in what the majority of PAHO participants prefer to call “articulated medicine.” Rationale: Increasingly, many active in advancing integrative medicine and health have begun to view the movement as global and intertwined and supportive of the WHO’s effort to optimize the role of traditional and complementary health products, practices, and practitioners in meeting the goal of primary care for all. Yet knowledge is limited among the integrative health community in the better resourced nations of North America, Europe, and Asia of the directions urged by the WHO in its 2014–2023 Traditional Medicine Strategy. For instance, the Academic Consortium for Integrative Medicine and Health and the Academic Collaborative for Integrative Health each endorsed the 2017 “Berlin Agreement: Self Responsibility and Social Action in Practicing and Fostering Integrative Medicine and Health Globally” (https://www.ecim-iccmr.org/fileadmin/ecim-iccmr/editors/documents/Berlin_Agreement_on_Self-Responsibility_160417.pdf). That global vision is of an integrative model that draws not only on biomedicine but also on “traditional medicine practices” and “respects multiple philosophies” recognizing that “traditional medical products, practices and practitioners are the main access to healthcare in most regions of the world.” The PAHO, which serves as the WHO regional office for the Americas Region, is fostering cooperation for traditional and complementary medicine integration into health-care systems among its member states. This panel helps bridge this knowledge and opportunity gap through presentations from professionals who provided advice and leadership in developing PAHO and WHO strategies, and others working inside South American and Central American nations to achieve the goals. Among the topics will be that of emerging partnerships and opportunities. Participants will be introduced to the concept of “articulated medicine” that was favored in a voice vote by representatives of traditional medicine systems, from nearly 2 dozen nations at a mid-2017 WHO-PAHO meeting in Managua, Nicaragua in which efforts to create a regional collaborative network were formally endorsed. Objectives: The aim is to describe how WHO and PAHO and some individual nations are engaging T&CM and promoting research, explain why many in Central and South American nations favor depicting the integrative effort via a concent of “articulated medicine” rather than “integrative medicine,” identify priority T&CM research needs of PAHO member states, evaluate the challenges and opportunities of existing and potential collaborations with academic health institutions and delivery organizations, and discuss possible partnership strategies for researcher and institutions. Outline: The panel will be opened by the moderator–organizer (Weeks) who served on workshops that led to the WHO strategy and participated in the PAHO meeting. He will help set the context of the WHO strategy and open some of the issues that emerged in the PAHO meeting (5–10 min). This will be followed by presentation from the other panelists: • Fabrega will share more on the WHO-PAHO link and the context of PAHO interest in traditional, complementary integrative medicine, as well as its articulation to PAHO’s Strategy for Universal Access to Health and Universal Health Coverage (10 min). • Gallego-Perez will offer details of PAHO’s current activities and emerging partnerships and provide examples of the diversity of T&CM activity in a selected set of nations (10 min). • Parker will share information from a long-standing clinical offering in Nicaragua that serves an underserved population and offers global service learning opportunities to health professional students (10 min). • Miele-Amado will offer insight into TC&M integration in the health system and research initiatives in Brazil (10 min). This will leave time for limited discussion in a 60 min panel. We would prefer 90 min or at least 75, for more dialogue with the audience, and the potential to expand one or more of the talks to 12–15 min. (3422) Probiotics and Gastrointestinal Conditions: An Overview of Evidence From the Cochrane Collaboration Elizabeth A Parker, PhD, RD1, Christopher R D'Adamo, PhD1, Tina Roy, BS2 and L Susan Wieland, PhD3 1University of Maryland School of Medicine, Baltimore, Maryland 2Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania 3Baltimore, Maryland Abstract Purpose: Alterations in the gut microbiota are associated with numerous gastrointestinal (GI) conditions. Probiotics, live microorganisms that may confer a health benefit to the host when consumed, are increasingly used to treat GI conditions. Our objective was to summarize the evidence on probiotics and GI conditions available from Cochrane, a nonprofit organization that produces rigorous systematic reviews of health interventions. Results: Fourteen Cochrane reviews published between 2006 and 2015 focused on probiotics and GI conditions (diarrhea, N = 5; colitis, N = 4; Crohn’s disease, N = 3; liver conditions, N = 2). One review on liver conditions identified no trials; the remaining 13 reviews included 1–63 trials with 11–8014 participants. The exclusive N of probiotic combinations included in each review ranged from 1 to 21; Lactobacillus rhamnosus GG was the most commonly studied. In total, 63% of included trials specified probiotic strain, 94% reported dosage, 79% specified intervention length, 29% indicated follow-up duration, and 73% reported AEs. Four reviews on diarrheal conditions reported that probiotics were beneficial; all other reviews were inconclusive. Conclusions: There is good evidence for the efficacy of probiotics for diarrheal conditions; however, reviews on probiotics for other conditions require further updating to establish efficacy. Future clinical trials and systematic reviews of probiotics should specify important and often unreported information about the species, strain, manufacturing processes and storage conditions of the tested probiotics, and the duration of follow-up. Findings from this review will help improve future probiotics research and the development of clinical guidance on their use. (3424) Practical Tools for Building Clinician Resilience and Reducing Burnout Michelle L Dossett, MD, PhD1 and Darshan Mehta, MD, MPH1 1Massachusetts General Hospital, Boston, Massachusetts Abstract Overview: Over the past decade, a growing number of studies have demonstrated that programs incorporating mind–body practices, cognitive behavioral tools, appreciative inquiry, narrative medicine, and community-building exercises can reduce burnout in health-care professionals. This workshop will briefly review published data on burnout and resilience and introduce participants to the Stress Management and Resiliency Training (SMART) program developed at the Benson-Henry Institute (BHI) for mind–body medicine. Participants will gain familiarity with the comprehensive resiliency tool kit that comprises the SMART program and engage in several experiential exercises taught in the program to develop awareness of tools used to build resiliency in different domains. The workshop will introduce practical tools that busy clinicians can incorporate into their lives and include time for question and answer (Q&A). The SMART program is typically conducted for 2 h weekly over 8 weeks. It has been tested in, and shown to be efficacious among, a number of different patient populations and in health-care providers. Rationale: This workshop addresses both burnout and resiliency and introduces clinicians to a range of practical, evidence-based tools that they can incorporate into their personal and professional lives at any stage of their career. This workshop also introduces clinicians to a multimodal, evidence-based framework for thinking about resilience and provides a model (the BHI’s SMART program) for future exploration of resiliency tools. The SMART program is the outgrowth of years of clinical experience and research and one of few such programs currently in existence. This multimodal resiliency program targets stress with 3 main components: mind–body skills building (participants are taught a variety of different meditation techniques, minirelaxations, walking meditation, and yoga), traditional stress awareness/management techniques to decrease stress reactivity, and practicing adaptive strategies through healthy lifestyle behaviors (sleep, exercise, nutrition, and social support) and cognitive reappraisal and adaptive coping skills (borrowed from cognitive behavior therapy, acceptance commitment therapy, and positive psychology). The program is offered in a group format which includes interactive and narrative exercises and helps to build a sense of community. Objectives: The aim is to describe the physiologic mechanisms by which mind–body practices reduce the stress response, explain how mindful practice can enhance patient care and communication skills, list 5 techniques for increasing resilience to stress and demonstrate 3 such approaches, and describe a comprehensive framework for increasing resilience to stress. Outline: • Background on burnout—definition, frequency, and consequences • Resilience as a construct to counteract burnout, meta-analyses, and potential solutions • The science of mind–body medicine, mindful practice, and benefits for patients and providers • Guided meditation practice and debriefing and introduction to minirelaxations • Overview of the SMART program resiliency model and its main components • Energy battery exercise • Introduction to cognitive skills • Appreciation exercise • Building empathy—loving kindness meditation and mini • Summary • Q&A (3472) Let’s Stop the Opioids! An Experiential Workshop on Nonpharmacologic Therapies for Pediatric Pain Management Erica Sibinga, MD1, Shiu-Lin Tsai, MD2, Kathi Kemper, MD3, Sanghamitra M Misra, MD4 and Danielle Graff, MD5 1Johns Hopkins University School of Medicine, Baltimore, Maryland 2Columbia University, New York, New York 3The Ohio State University, Columbus, Ohio 4Baylor College of Medicine, Houston, Texas 5University of Louisville, Louisville, Kentucky Abstract Overview: In response to the opioid epidemic in our country, numerous government agencies including the Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) have made official recommendations for nonpharmaceutical approaches for the treatment of pain. Participants will be introduced to 4 evidence-based therapies for pediatric pain management: autogenic training, mindfulness, meditation/breathing techniques, and acupuncture. All 4 modalities have shown benefits for pain. Attendees will experience each therapy firsthand and learn at least 1 practical application to take back for immediate clinical use. Rationale: In response to the opioid epidemic in our country, numerous government agencies including the CDC and FDA have made official recommendations for nonpharmaceutical approaches for the treatment of pain. More recently, the National Institutes of Health, the U.S. Department of Defense, and the U.S. Department of Veterans Affairs are partnering to expand research of nonpharmacologic approaches to pain management. Not uncommonly, opioid addiction begins with legitimately prescribed narcotic usage. Furthermore, increased morbidity and mortality has been reported in pediatrics, including multigenerational effects as seen in the rise of neonatal abstinence syndrome and opioid associated brain changes in newborn babies affecting later development. Given these alarming opioid-associated sequelae, effective nonopioid treatment options for pain are urgently needed. Objectives: Participants will be introduced to 4 evidence-based therapies for pediatric pain management: autogenic training, mindfulness, meditation/breathing techniques, and acupuncture. All attendees will experience each therapy firsthand and learn at least 1 practical application to take back for immediate clinical use. Outline: Autogenic Training—Autogenic training is a simple, effective self-hypnosis tool to help manage pain and stress in patients of all ages. Repeating 6 simple phrases quickly leads to deep relaxation within minutes. Participants will experience this for themselves and then have the opportunity to lead others in the exercise, practicing in a safe space prior to taking this tool home to use with patients. Mindfulness—Mindfulness has been described as nonjudgmental, present-focused awareness and has been shown to be beneficial for mental health, coping, and pain management. The evidence for mindfulness benefits will be reviewed, and mindfulness concepts and formal and informal techniques will be experienced and discussed. Session participants will learn simple mindfulness concepts and techniques which can be used for both practitioners and patients alike. Meditation/Guided Imagery/Breathing Techniques—Meditation, guided imagery, and breathing techniques can help manage stress and pain in children of all ages. These techniques are simple to teach patients, even in a busy office practice. Children feel empowered once they learn to manage their own symptoms. Participants will learn to utilize simple tools that can be used with patients. Acupuncture—Attendees will experience and learn 2 auricular acupuncture protocols: 1. Battlefield acupuncture to treat pain in general, currently used in the United States military 2. Another standardized protocol to abort migraine headaches (3475) Transformational Learning in Educating Health-care Professionals for Integrative Medicine and Health Christian Scheffer, MD, MME1, Diethard Tauschel, MD1, Mary J Kreitzer, PhD, RN2 and Sian Cotton, PhD2 1Faculty for Health, Witten Herdecke University, Witten, Germany 2Cincinnati, Ohio Abstract Overview: Transformational learning is the process of deep, constructive, and meaningful learning that goes beyond simple knowledge acquisition and supports critical ways in which learners consciously make meaning of their lives. Meaning making is central for patients to cope with diseases in a productive way as well as in students to become engaged and self-reflected heath-care professionals. This session will discuss different educational interventions to foster transformational learning in different stages of education in different educational settings including the beginning of undergraduate medical education: learning workshop to become a self-directed learner at medical school; during undergraduate education of health-care professional students: an interprofessional student wellness retreat; at the end of undergraduate medical education: supported active participation at integrative clinical education wards; and creating a learner-centered environment. Rationale: For patients, suffering with an illness is strongly connected with transformational experiences questioning the way of living in a fundamental way. In order to prepare future health-care professionals to support patients in such challenging situations, learning is needed promote the transformation from the student role to a responsible health-care professional. We will present and discuss different student-centered educational activities to promote transformational learning based on exposing to and guiding students in life-changing experiences in different settings. A focus will be on collaborative learning with peers as well as in interprofessional settings. Objectives: Participants will be able to understand the value of transformational learning for health-care students, distinguish different educational methods to promote transformational learning, and describe the value of collaborative learning to support self-reflection and self-transformation. Outline: • Learning workshops to promote self-directed learning at medical school (D Tauschel) • Interprofessional student wellness retreat (S Cotton) • Becoming a doctor: Guiding transformational learning during participation at integrative clinical education wards (C Scheffer) • Integrating well-being practices into learning environments (MJ Kreitzer) (3484) Neuroscience of Compassion: Multidimensional Construct and Integrative Health Skill Yi-Yuan Tang, PhD1, Poppy Schoenberg, PhD2, David Vago, PhD2 and Jonathan Greenberg, PhD3 1Texas Tech University, Lubbock, Texas 2Osher Center for Integrative Medicine, Nashville, Tennessee 3Massachusetts General Hospital, Boston, Massachusetts Abstract Overview: The construct of compassion is multifaceted. It is broadly defined as the feeling that arises in witnessing another’s suffering, alongside the subsequent intention/motivation to help. Extant emotion research often conflates the construct with emotional processes such as empathy, sympathy, distress, sadness, self-compassion, and even love. Within social psychology, compassion is often framed as a virtuous characteristic and determinant to prosocial altruistic behavior that transcends self-referential processes. As such, moral psychology proposes compassion as foundational to ethical judgment and behavior. Here, we examine the concept of compassion as an empirical, multifaceted construct through the lens of neuroscience. Specifically, what are the distinct neurobiological substrates of compassion and its analogues, and can it thus be considered as a “skill”, or group of skills, that may be developed? Can the multifaceted construct of compassion involve multiple neurobiological markers and be intentionally modulated? What implications would this have for clinical, research, and educational settings toward the advancement and optimization of integrative medicine and health? From an integrative health perspective, clarifying the conceptual and neurobiological processes subserving compassion will facilitate consistent empirically informed clinical care, in addition to being good medicine. Rationale: Compassion presents a central tenet of integrative health and healing. Albeit, as a multifaceted construct, understanding and advancing awareness of this operationalization and set of associated practices has important implications for the integrative health field. This topic is relevant for the following reasons: (1) from a clinical practice perspective, ensuring interventions appropriately emphasize compassion-based care is pertinent for the successful delivery of integrative health, ensuring patients are served in the most optimal method for their complex clinical needs. Essentially, incorporating a framework wherein compassion is described and embodied as a set of “skills” that can be harnessed within integrative medical training; (2) disseminating the extant research base regarding compassion as a multifaceted construct with associated set of practices that cultivate it, may contribute to advanced clinician awareness and development of compassion research, particularly as a tool for working with “difficult” clinical cases, and personal experiences of “burnout”; (3) specific to the 2018 Integrative Medicine congress theme, ensuring the field remains collaborative, consistent, and that high-level decisions regarding clinical practice, education, and research emphasize compassion-based care, and a more comprehensive understanding of the mechanisms of compassion at the individual biological and collective sociopsychological levels. Objectives: The aim is to examine compassion as a multifaceted construct, alongside understanding the extant proposed clinical neurobiological models; review the current neuroscientific research on neurobiological substrates and mechanisms of compassion and its analogs (eg, empathy, prosocial behavior, self-compassion); and synthesize the presented models and empirical data, in terms of how it may be applied specifically to advancing integrative health research, education, and clinical practice. Outline: 1. Compassion is a multifaceted construct, encompassing biological, social, psychological, and moral/ethical components. 2. Empirical data suggest compassion can be disambiguated from distinct emotional processes (eg, distress, sadness, self-compassion, and love), with quantifiable neurobiological substrates. 3. Based on neuroplasticity, compassion could be regarded as a set of skills, which can be intentionally modulated and enhanced. 4. The implications for the integrative medicine field will be explored. That is, compassion is not only good care; it may also represent an advanced platform for clinical practice, education, and research. (3513) Conducting and Translating Research for Policy-makers: A Case Study of Acupuncture Coverage by Vermont Medicaid and Blue Cross Blue Shield Robert Davis, MS1 and Remy Coeyteux, MD, PhD1 1Winston-Salem, North Carolina Abstract Overview: Results from the “acupuncture for chronic pain in the Vermont Medicaid population” trial will be presented in a symposium format in order to expand the discussion to include strategies that may enhance the likelihood that research will have policy impacts. The story begins with the opioid crisis and brings together a diverse set of Vermont stakeholders, including state legislators, health care and insurance officials, the medical community, the licensed acupuncturist workforce, and a population of underserved Medicaid patients who suffer from chronic pain. The format will provide attendees with a deeper context and insight into the unique challenges, constraints, and rewards of working in a pragmatic, policy-oriented, and politicized research environment. Rationale: This symposium aims to stimulate thinking and provoke action by integrative medical providers and researchers in the health services/public policy arena. It is important because it will provide a rare example of a U.S.-based pragmatic, prospective intervention trial with patient centered and qualitative outcomes. The population studied is an underserved group. The design was optimized for generalizability to the Vermont health-care environment in order to inform health-care policy decisions. Our discussion will extend beyond the trial design and results to include the unique challenges and opportunities encountered during this project. Attendees will also benefit from a description of our successful effort to challenge and educate Vermont Blue Cross Blue Shield (BCBS) officials regarding their incomplete and erroneous assessment of the state of the evidence regarding acupuncture for the treatment of chronic pain. Objectives: We aim to remind attendees about the continuum between explanatory and pragmatic trials and the importance of matching each element of the design with the research question being asked; inform attendees about the effectiveness of acupuncture in a Medicaid population of chronic pain patients in the domains of pain intensity, pain interference, sleep disturbance, fatigue, anxiety, depression, physical function, and social isolation; provide attendees with potential strategies for translating and contextualizing existing data and research evidence into formats of use for both expert and nonexpert health-care policy decision makers; and provide attendees with insight into the opportunities that were created when a crisis disrupted the usual health-care status quo. Outline: (90 min total) Background: Opioid crisis and Vermont Act 173—mandated BCBS report and Medicaid pilot study described as follows (10 min): BCBS VT report to legislature about acupuncture for chronic pain. Rebuttal of report and discussions, relationships, and policy changes that ensued (10 min). Acupuncture for chronic pain in the Vermont Medicaid population—study (40 min) ○ design and rationale—challenges and constraints ○ results ○ ensuing policy changes Discussion (30 min) ○ challenges working with the state bureaucracy to get the study started ○ evolution of relationships with Medicaid and BCBS officials ○ loss/turnover of key Medicaid officials during the study due to election of new governor ○ importance of contextualizing evidence, risks, and benefits of acupuncture with opioids and other analgesic medications when considering policy decisions ○ self-care and biopsychosocial benefits of acupuncture as demonstrated by our data and other literature fit well with National Pain Strategy recommendations (3520) Pediatric Massage: A Nonpharmacologic Intervention for Children With Pain, Stress, and Chronic Conditions Tina Allen, LMT, CPMMT, CPMT, CIMT1, Maria Mascarenhas, MBBS and Winona Chua, MD2 1Children’s Hospital of Philadelphia, Vancouver, Washington 2Philadelphia, Pennsylvania Abstract Overview: Massage therapy has been found to be beneficial in many clinical conditions. This is particularly true in children who have an essential need for tactile stimulation to further their growth and development. Touch stimulates the brain, including the limbic cortex, which is the area of the brain where emotions are generated. Massage therapy has been shown to reduce cortisol (stress hormone) levels. Receiving professional touch therapy can aid in healthy development and can be a vital source of healing. Those who receive massage therapy may experience benefits including decrease in anxiety, improvement in pulmonary function, reduction of pain, and fostering an overall sense of well-being. Given the concern for opioid overuse, pediatric massage therapy may be an important complementary approach for the nonpharmacologic management of chronic pain. During this session, participants will learn about the benefits of pediatric massage through a review of available research as well as the indications for pediatric massage therapy. There will be a demonstration and hands-on practice of simple pediatric massage protocols, including those which aid in decreasing anxiety, stress, and pain, and those that can be used to manage some common pediatric conditions like constipation. Participants will learn developmentally appropriate adaptations of common pediatric massage techniques and will take away applications that will add to a health-care provider’s professional practice and integrative tool kit. Rationale: Pediatric massage therapy is a simple, noninvasive, low-tech, and highly effective clinical intervention. Available evidence for its effectiveness is increasing. Since it is portable and can be easily taught to health-care providers and parents, it is an important and useful skill for integrative health-care providers to have. Objectives: The aim is to know the indications and importance of pediatric massage therapy; be aware of the evidence that supports the use of massage therapy in pain and chronic conditions, including developmentally appropriate adaptations; and demonstrate a series of massage strokes that may be especially beneficial to pediatric patients. Outline: • Background and literature review to support the use of pediatric massage • Hospital- and ambulatory-based strategies for pediatric massage, including examples of current usage in pediatric health care • Simple hands-on protocols that are demonstrated and practiced during the workshop (3535) Mechanisms Underlying the Antidepressant Response of Acupuncture via JNK Signaling Pathway Qiuyun Yu1, Tuya Bao1, Huili Jiang1, Bingcong Zhao1 and Xinjing Yang1 1Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: To observe the effect of acupuncture on JNK signaling pathway in rats with chronic unpredicted mind stress (CUMS), so as to reveal the underlying mechanism of acupuncture for depression. Results: CUMS could induce depressive-like behaviors. The expression of JNK, c-jun, and p-c-jun were upregulated by CUMS in model group, model+SP group, and model+DMSO group compared with the control group (P < .01). Compared with model group, the expression level of each protein in model + DMSO group showed no significant difference (P > .05). The expression level of JNK in model + SP group, FLX group, and FLX + SP group showed no significant difference compared with model group (P > .05), while in acupuncture group and acupuncture + SP group, JNK expression level showed significant difference (P < .01). The expression level of c-jun was reduced significantly in model + SP group, FLX group, FLX + SP group, acupuncture group, and acupuncture + SP group (P < .05). The expression level of p-c-jun was reduced significantly in FLX group, FLX + SP group, acupuncture group, and acupuncture + SP group (P < .01). Compared with FLX group, the expression of the 3 proteins in FLX + SP group showed no significant difference (P > .05). Compared with acupuncture group, the expression of the 3 proteins in acupuncture + SP group also showed no significant difference (P > .05). Conclusions: Acupuncture could ameliorate depressive-like behaviors by regulating-related proteins on the JNK signaling pathway in the prefrontal cortex. (3557) Differential Mechanisms of Stress Reduction Following the Mindfulness-based Stress Reduction and Relaxation Response Programs Adrienne McCallister, PhD1, Micheal Treadway, PhD2, Jeffery A Dusek, PhD, James Carmody, PhD, Gunes Sevinc, PhD3, Javeria Hashmi, PhD4, Marissa L Schneider, BA3, Britta Holzel, PhD5, Sara W Lazar, PhD1 and Jonathan Greenberg, PhD1 1Massachusetts General Hospital, Boston, Massachusetts 2Emory University, Atlanta, Georgia 3Boston, Massachusetts 4Dalhousie University, Halifax, Nova Scotia, Canada 5Technical University of Munich, Munich, Germany Abstract Purpose: The mechanisms through which stress reduction programs promote wellness are important for understanding the treatment of stress and stress-related disorders. In this study, we compared 2 different meditation-based programs, in order to explore any potential differential impact on stress-reduction and neural activity. Results: Both programs reduced perceived stress and increased mindfulness. The relaxation response (RR) program was exclusively associated with stronger functional connectivity of the right inferior frontal gyrus—an important hub of intentional inhibition and control—with supplementary motor areas during the bodyscan. The mindfulness-based stress reduction (MBSR) program was exclusively associated with improvements in self-compassion and rumination and with significant functional connectivity of the right anterior insula—an important hub of sensory awareness and salience—with pregenual anterior cingulate during bodyscan meditation compared to rest. Conclusions: These findings indicate that the different types of bodyscan exercises were associated with different mechanisms: inhibitory control-related mechanisms in RR and emotion regulation and sensory awareness-related mechanisms in MBSR. These results may have potential implications for the differential effects of mind–body interventions as well as their utilization for the treatment of diverse conditions. (3564) Receipt of an Opioid Prescription Among Veterans of Recent Wars Using Chiropractic Care Anthony J Lisi, DC1, Christine M Goertz, DC, PhD2, Lori A Bastian, MD, MPH3, Kelsey L Corcoran, DC3, Eric C DeRycke, MPH3 and Cynthia A Brandt, MD, MPH3 1VA Connecticut Healthcare System, West Haven, Connecticut 2Palmer College of Chiropractic, Davenport, Iowa 3New Haven, Connecticut Abstract Purpose: This study aims to examine patient factors associated with opioid use among Veterans of Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) who receive chiropractic care. Results: We identified 14 025 OEF/OIF/OND Veterans with a chiropractic care visit: mean age was 38 years; 15.8% were women; 56% reported moderate/severe pain intensity; 54.2% had a diagnosis of post-traumatic stress disorder (PTSD) and 47.6% had a diagnosis of depression. Overall, 4440 (31.6%) Veterans received one or more opioid prescription. Moderate/severe pain (odds ratio [OR] = 1.88, 95% confidence interval [CI] = 1.73–2.04), PTSD (OR = 1.57, 95% CI = 1.43–1.71), depression (OR = 1.42, 95% CI = 1.30–1.55), and current smoking (OR 1.38, 95% CI = 1.26–1.51) were associated with a higher likelihood of receiving an opioid prescription. Conclusions: Opioid use among Veterans receiving chiropractic care was common and was associated with several clinical factors. This highlights the need to assess the characteristics and treatment outcomes of those Veterans receiving opioids before and/or after initiating chiropractic care. (3567) Human Subjects Research, National Institutes of Health Clinical Trials Policy, and Implications for Your Research Wendy Weber, ND, PhD, MPH1, Wen Chen, PhD1, Martina Schmidt, PhD1 and Christine Wishnoff, MPH1 1National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland Abstract Overview: Scientific disciplines can differ on what elements of a study are necessary to meet the definition of a clinical trial. National Institutes of Health (NIH) defines the term broadly, “A research study in which one or more human subjects are prospectively assigned to one or more interventions (which may include placebo or other control) to evaluate the effects of those interventions on health-related biomedical or behavioral outcomes.” As NIH finalizes the implementation of this definition, many changes will impact investigators submitting applications with human subjects including newly formatted funding opportunity announcements, new grant application forms and elements, good clinical practice training certification requirements, and registering and reporting requirements for funded projects. These elements have been implanted as part of NIH’s ongoing efforts to enhance rigor and reproducibility of clinical research. For example, NIH defines intervention as a manipulation of a person or a person’s environment to modify one or more health-related biomedical or behavioral processes and/or end points. Researchers in complementary and integrative health studying the basic science or mechanisms of these approaches may find that their projects now fall within the rubric of NIH clinical trials. This session will include a brief overview of the NIH clinical trial definition and several new policies related to the implementation of this definition. Presenters will orient participants to the newly implemented categories of NIH funding opportunity announcements to help investigators submit applications for peer review. Speakers will also provide an overview of how National Center of Complementary and Integrative Health (NCCIH) is implementing these policy changes with attention to the new NCCIH clinical trial-specific funding opportunity announcements. Panelists also will provide links to online resources they can access to aid them in understanding these major policy changes at NIH. Rationale: Much of the research presented at the International congress on Integrative Medicine and Health is fully or partially funded by the NCCIH. Nearly 60% of the research supported by NCCIH include human participants. Thus, the majority of the applications submitted to NCCIH by investigators attending the International Congress on Integrative Medicine and Health meeting will be impacted by these policy changes at NIH. This session will inform attendees about the policy changes, why they were made, and how it will directly impact them as they apply for funding from NIH and NCCIH specifically. The session relates to both the policy and clinical research themes of the Congress. Objectives: The aim is to understand how NIH policy changes for human subjects research may impact investigators’ ongoing research studies and future applications for NIH funding, identify which funding opportunity announcements can be utilized by investigators who want their applications assigned to NCCIH for funding consideration, assist investigators in deciding which available funding opportunity is the best fit for the types of research that NCCIH supports, understand new review criteria for NIH-defined clinical trial applications, learn about NCCIH methods for oversight of human subjects research to enhance rigor and reproducibility goals at NIH, and learn about resources available to investigators to assist them in the application process. Outline: • Overview of NIH policy changes for human subjects research • Summary of the impact these policy changes will have on investigators’ ongoing research as well as new applications • Overview of NCCIH-specific funding opportunities for clinical research and basic and mechanistic research with human participants • Summary of the new elements of clinical trial applications to NIH, new form components, special attachments, and updated review criteria • Description of the oversight activities NCCIH uses to assure rigor and reproducibility (3575) Do One, Teach One, See One: Flipping the Medical Learning Paradigm From Passive to Active Elaine Cheung, PhD1, Rupa Mahadevan, MD1, Melinda Ring, MD, FACP1 and Sreela Namboodiri, MD1 1Chicago, Illinois Abstract Overview: This session is intended for faculty or trainees involved in any form of education in the field of integrative health. Active learning strategies can increase students’ motivation; improve their participation, confidence, and interpersonal skills; and encourage them to be involved in higher order thinking. Engaging students through active learning techniques such as changing lectures to prework videos, in-class role playing, case discussion, coaching, and project-oriented hands-on learning can help engage all students by making them an integral part of the learning process. During this workshop, participants will learn strategies for incorporating active learning to support their learning objectives, practice several forms of active learning with colleagues, and formulate a plan for incoproration of at least one new active learning strategy into their own work. By the conclusion of this workshop, participants will be able to remember and understand key concepts and terms related to active learning, be comfortable enough to implement at least 1 active learning strategy in his or her teaching, evaluate the suitability of an active learning exercise for a given course situation, be able to relate active learning to other teaching methods, understand some of the personal and social implications of using active learning in his or her classroom, care about learning more about active learning, and have a list of resources for learning more about active learning. Rationale: This workshop addresses integrative medicine education teaching methods and curriculum development, as well as the process of collaboration with colleagues both within and outside of the medical field to enrich curriculum development. Medical schools struggle with finding time for required coursework within student’s schedules, and integrative medicine and lifestyle focused topics are often given inadequate time in the core curriculum, or relegated to electives or clubs. When presented as a required curriculum, a subset of the learners may come with preconceived biases against integrative and complementary medicine, or feel the content is not valuable and worth attention compared to more conventional training such as anatomy and pharmacology. Engaging students through active learning techniques such as role playing, case discussion, coaching, and hands-on learning can help engage all students by making them an integral part of the learning process. Active learning can also be used in smaller groups when offered outside of usual class time, when students may need a more engrossing experience to maintain their interest levels. While shifting from traditional lectures to active learning can require additional work by faculty during the preparation phase, it can lead to a greater enjoyment of teaching by fostering greater interactions with students. Ultimately, inviting students to participate in the learning environment gives them greater responsibility and allows students to see a course as more valuable and directly related to their goals, thereby creating a more fulfilling experience for faculty and students alike. Objectives: This session is intended for faculty or trainees involved in any form of education in the field of integrative health. Active learning strategies can increase students’ motivation; improve their participation, confidence, and interpersonal skills; and encourage them to be involved in higher order thinking. During this workshop, participants will learn strategies for incorporating active learning to support their learning objectives and practice several forms of active learning with colleagues. By the conclusion of this workshop, participants will be able to remember and understand key concepts and terms related to active learning, be comfortable enough to implement at least 1 active learning strategy in his or her teaching, evaluate the suitability of an active learning exercise for a given course situation, be able to relate active learning to other teaching methods, understand some of the personal and social implications of using active learning in his or her classroom, care about learning more about active learning, and have a list of resources for learning more about active learning. Outline: Active learning is a process whereby students engage in activities that promote analysis, synthesis, and evaluation of class content. Active learning stands in contrast to standard modes of instruction in which teachers do most of the talking and students are passive. Cooperative learning, problem-based learning, and the use of case methods and simulations are some approaches that promote active learning. In this session, we will review several approaches to active learning, using as a case example their incorporation within a Culinary Medicine elective at Northwestern Feinberg School of Medicine, developed by faculty from the Osher Center for Integrative Medicine in partnership with the nonprofit organization Common Threads. 1. Flipped classroom—creating short video segments for prehomework rather than classroom passive lectures 2. Case-based improvisational patient coaching exercises 3. Student-led discussion of an assigned article 4. Active hands-on learning (culinary session) and mindful meal together 5. Learning through teaching (medical students volunteer in a Chicago Public School to teach children about nutrition) 6. Social media—the use of Facebook or Google Classroom as a forum for active exchange of ideas between classes (3595) Impact of Mind–Body Programs on Dietary Behaviors and Attitudes Carl Fulwiler, MD PhD1, Ruth Q Wolever, PhD1 and Sara Lazar, PhD1 1Charlestown, MA Abstract Overview: Many studies have investigated mindfulness-based weight loss programs. Relatively little is known about the utility of using mindfulness to maintain significant weight loss. This symposia focuses on 3 National Center of Complementary and Integrative Health-funded studies to explore the impact of mindfulness on dietary attitudes and behaviors as well as psychosocial and neural measures that might support changes in eating and exercise habits. Two presenters studied mindfulness programs explicitly designed for weight loss maintenance, the third presenter studied changes in dietary behaviors following a yoga-based stress reduction program that did not include any explicit dietary content. Rationale: Many individuals who successfully lose significant amounts of weight will regain the weight within 1 year. New approaches are needed to help these individuals change their dietary habits and maintain their weight loss. Objectives: Participants will (1) gain an understanding of how mind-body practices impact dietary habits and attitudes and (2) how psychosocial factors such as self-efficacy, body awareness, and self-compassion mediate these changes. Outline: The first speaker will present findings from a pilot randomized controlled trial of overweight individuals who are trying to maintain weight loss randomized to either mindfulness-based stress reduction or an active control. Measures to be reported include pre–post resting state functional connectivity, and pre–post and 6-month body weight, dietary behavior, emotional eating, exercise, and psychological predictors. The second speaker will present results of a qualitative interview conducted with 14 participants 12–18 months following a mindfulness-based weight maintenance intervention to understand how they had or had not incorporated mindfulness into their daily lives relative to eating. Results include changes in awareness of bodily sensations, differences in behavior and emotions, shifts in attention, thinking and decision-making, and increased awareness of long-term, higher order values. The third speaker will present findings from a pilot study that assessed changes in dietary attitudes and behaviors in stressed individuals who were not explicitly trying to change their weight or eating habits, and in the absence of any programmatic dietary/weight loss content. Results include changes in caloric intake and dietary quality, emotional eating, self-efficacy, self-compassion, and body awareness. (3600) Looking Back, Looking Forward: National Center for Complementary and Integrative Health at 20 Margaret A Chesney, PhD1, Christine M Goertz, DC, PhD2, Emmeline Edwards, PhD3, David Shurtleff, PhD3 and Anita McRae-Williams, MA3 1San Francisco, California 2Palmer College of Chiropractic, Davenport, Iowa 3National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland Abstract Overview: The National Center for Complementary and Integrative Health (NCCIH) is the lead federal agency for scientific research on the usefulness and safety of complementary and integrative health practices. The Center was established, by Congressional mandate, under provisions of the Omnibus Appropriations Bill (P.L. 105-277). This bill amended Title IV of the Public Health Service Act and elevated the Office of Alternative Medicine (OAM) to a National Institutes of Health (NIH) Center. In 1998, Congress expanded the status, mandate, and authority of OAM by enacting legislation to create the National Center for Complementary and Alternative Medicine (NCCAM). The Center was later renamed NCCIH by a second congressional mandate as part of the omnibus budget measure signed by President Obama. The Center’s charge is to “conduct basic and applied research (intramural and extramural), research training, and disseminate health information and will identify, investigating, and validating CAM treatments, diagnostic and prevention modalities, disciplines and systems.” This International Congress on Integrative Medicine and Health (ICIMH) symposium will highlight NCCIH history, philosophy, current directions, and research portfolios. Dr Christine Goertz, vice-chancellor for Research and Health Policy, Palmer College of Chiropractic, member of NCCIH/NIH Advisory Council, and former program officer at NCCIH, will give the historical perspective for NCCIH scientific program developments in the early years. Dr Margaret Chesney, professor of medicine at the UCSF Osher Center for Integrative Medicine and former deputy director and director, DER, and training at NIH/NCCIH, will comment on the middle years and the challenges encountered in integrating the Center’s programs to the NIH biomedical research enterprise. Dr Emmeline Edwards, director, DER, will highlight NCCIH current vision and will update the ICIMH community on highlights of her 2012 closing session of the ICIMH meeting. Finally, Dr David Shurtleff, NCCIH acting director, will discuss the Center’s 2016 strategic plan and future vision and high-priority research topics. Rationale: NCCIH is the world’s largest funder of research on complementary and integrative health. To address the need for objective evidence as to the safety and efficacy of complementary and integrative health approaches, NCCIH supports rigorous scientific investigation to better understand how these interventions work, for whom, and the optimal methods of practice and delivery. The Center’s strategic priorities have been shaped by real-time developments in science, medicine, and health care. The Center stresses the importance of basic/mechanistic and clinical research as the core of building the evidence base for complementary and integrative health approaches. NCCIH has developed and implemented a research framework that also brings the methods of effectiveness and outcomes research to the real world where public use is extensive. This ICIMH symposium will be an excellent forum to discuss NCCIH’s history and continued commitment to advance the science of complementary and integrative health, to build state-of-the-art research capacity through targeted training and career development programs, to foster multidisciplinary collaborations, and to provide objective and authoritative evidence-based information to the public and health-care professionals. Objectives: Participants at the ICIMH symposium will gain in-depth knowledge of the Center’s vision and mission. The 4 presentations will offer the historical perspective, a sense of the philosophy that guides our research framework and a detailed view of the current and future research priorities for the Center. Outline: • Historical perspective—NCCIH creation and development of research programs • Integration of NCCIH programs at NIH • Program priorities and blue-sky vision for integrative health • 2016 strategic plan and future directions (3601) Traditional Medicine Perspectives and Treatment of Patients With Pain Emily Telfair, ND1, Betsy Miller, MS, CNS, LDN1, Marlysa Sullivan, PT, C-IAYT, MS1 and Tyme Gigliotti, DAc, LAc1 1Maryland University of Integrative Health, Laurel, Maryland Abstract Overview: Traditional modalities have unique explanatory frameworks from which they approach and work with clients. This panel discussion will involve practitioners of yoga therapy, naturopathy, acupuncture, and herbalism presenting their discipline’s explanatory framework and approach to chronic pain. Specific applications of each discipline for working with chronic pain, including special considerations for the pain population, challenges, obstacles, and relevant research will be addressed. Challenges in integrating traditional perspectives and wisdom with a biomedical framework, along with recommendations, will be presented. Rationale: Understanding each distinct traditional perspective is essential for interprofessional dialogue in working with the chronic pain client. Objectives: At the end of the panel session, participants will differentiate various traditional approaches to chronic pain including explanatory frameworks; compare and contrast-specific applications of our various practices or treatments for pain, including challenges, obstacles, and relevant research pertaining to the traditional perspectives presented; and identify challenges of integrating evidence-informed practice into traditional perspectives and modalities. Additionally, the aim is to recommend for interprofessional communication and collaboration and discuss the approaches to research that honor traditional frameworks. Outline: Various practitioners of traditional modalities will discuss their unique approaches to relating to and treating their patients in the context of pain. (3603) Pain and Functional Trajectories in Symptomatic Knee Osteoarthritis Over a 12-week Period of Nonpharmacological Exercise Interventions Lori L Price, MAS, MLA1, Xingyi Han, MPH2, William F Harvey, MD, MSc2, Augustine C Lee, MD2, Jeffrey B Driban, PhD, ATC, CSCS2, Chenchen Wang, MD, MSc2 and Raveendhara R Bannuru, MD, PhD2 1Tufts University, Boston, Massachusetts 2Tufts Medical Center, Boston, Massachusetts Abstract Purpose: While exercise is the recommended treatment for knee osteoarthritis (OA), heterogeneous patterns in treatment response are poorly understood. We aim to identify pain and functional trajectories from exercise interventions among adults with symptomatic knee OA and explore their association with baseline participant factors. Results: We examined 171 participants (mean age 61 years, body mass index 32 kg/m2, 71% female, 57% white) and identified 4 pain trajectories: Lower early improvement (43%), moderate early improvement (32%), higher delayed improvement (15%), and higher no improvement (10%; Figure 1). We found similar trajectories for function, except the lower function trajectories diverged into gradual (12%) or delayed improvement (15%). Compared with the lower early improvement pain trajectory, moderate and higher pain trajectories were significantly associated with younger age, obesity, black race, and poorer physical and psychological health (Table 1). A similar pattern of significant associations were found among the functional trajectories (data not shown). Conclusions: We found 4 distinct trajectories for pain and function over 12-week exercise interventions among adults with symptomatic knee OA. While most participants experienced early improvements, subgroups with greater baseline pain/physical disability had either gradual, delayed, or no improvements. These findings help disentangle the heterogeneity of treatment response and may advance patient-centered care for these patients. (3607) Music, the Brain, and Chronic Pain Emmeline Edwards, PhD1, Wen Chen, PhD1, Sunil Iyengar, BS2, Catherine Bushnell, PhD1, Mathieu Roy, PhD3 and Joke Bradt, PhD4 1National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland 2National Endowment for the Arts, Washington, DC 3McGill College, Montreal, Québec, Canada 4College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania Abstract Overview: Music can get us moving, lift our mood, and even help us recall a special moment or event, but can it be used to relieve pain and improve well-being? This symposium will bring together some key players in the federal government and the research arena to present the latest scientific discoveries and governmental initiatives related to the possible interactions among music, the brain, and management of chronic pain. Sunil Iyengar, director of the Office of Research and Analysis at the National Endowment for the Arts, will provide a brief overview of the Federal Interagency Task Force on art-based therapies and introduce the concept of music as a game changer for brain health and its capacity to manage difficult symptoms like chronic pain. Dr Catherine Bushnell, scientific director of the National Center for Complementary and Integrative Health/National Institutes of Health (NCCIH/NIH) intramural research program, will present state of the science research on neural circuits and brain mechanisms engaged in pain perception and treatment. Dr Mathieu Roy, behavioral and cognitive neuroscientist at McGill University, will discuss our current understanding of brain mechanisms involved in music perception and production, with an emphasis on music reward processing and overlap with neural mechanisms of pain perception. Dr Joke Bradt, associate professor in the Department of Creative Arts Therapies at Drexel University, will describe some recent clinical research related to various forms of music therapy and their potential mechanisms of action for chronic pain management. Finally, Dr Emmeline Edwards, director for the Division of Extramural Research at NCCIH/NIH, and Dr Wen Chen, cochair of the “Music and Health” trans-NIH working group, will describe the Sound Health Initiative, discuss ongoing NIH research initiatives, and highlight gaps and opportunities in basic/mechanistic and clinical research on music and health. Rationale: Music is universally enjoyed regardless of culture, language, gender, ethnicity, and race. While the importance of music on our daily lives and its positive impact on our health are widely recognized, systematic and rigorous scientific studies are still lacking. The utilization of music-based therapies as a complementary and integrative approach for chronic pain management and opioid misuse remains largely unexplored. In early 2017, the NIH and the John F. Kennedy Center for the Performing Arts established the Sound Health initiative, a partnership initiated by Dr Francis Collins and the renowned opera singer Renée Fleming. The goal of this initiative is to increase our understanding of how music affects health, with emphasis on the basic neuroscience of music and potential clinical applications. One of the first activities of the Sound Health initiative was the January 26–27, 2017 workshop “Music and the Brain: Research across the Lifespan,” held at the main NIH campus in Bethesda, MD. Neuroscientists, music therapists, and supporters of biomedical research and the arts discussed basic and mechanistic ways that music affects the brain as well as the healing potential of music (or how music therapy can change, restore, or improve nonmusic behaviors). On June 2–3, 2017, the Kennedy Center and the NIH, in association with the National Endowment for the Arts, hosted Sound Health: Music and the Mind, a series of performances, lectures, and hands-on workshops that brought leading researchers in the field and performers to explore the intersection of music and science. This proposed State-of-Science International Congress on Integrative Medicine and Health (ICIMH) symposium will expand on these previous efforts with a focus on the potential impact of music on chronic pain and pain management. Objectives: Music has always been a topic of wide appeal and broad interest to the participants of the ICIMH meetings. In the 2016 ICIMH meeting, an experiential workshop on music attracted a room full of attendees, many of whom raised scientific questions about music and its impact on brain and health. This proposed symposium will provide the ICIMH attendees and participants in-depth insight into the science of music and health and include the following objectives: (1) present the current and cutting-edge scientific research on pain, music, and music therapies; (2) discuss the gaps and research opportunities in the field of music and health; and (3) encourage dialogues and discussions about the potential impact of music on pain management. Outline: 1. What is the current scientific evidence on how the human brain processes pain and manages the experience of chronic pain? 2. What is the current scientific evidence on how the human brain processes and creates music? 3. Are there any common brain regions involved in pain experience and music experience? 4. Can music therapy be used for chronic pain management? 5. What are the research gaps and opportunities in the study of music, its health impact, and connections to pain and pain management? (3611) Building the Infrastructure for Complementary and Integrative Health in VA: Lessons Learned From the VA Integrative Health Coordinating Center Kavitha Reddy, MD1, Alison M Whitehead, MPH1, Sara Grimsgaard, MHMS1, Juli Olson, DC, LAc1, Benjamin Kligler, MD, MPH1 and Belinda Collingbourne, MBA1 1Albany, NY Abstract Overview: Implementation of complementary and integrative health (CIH) across the Veterans Health Administration (VA) had been inconsistent and limited before Fiscal Year (FY) 2000. Given evidence of benefit, commitment to innovation, and desire to help patients with chronic pain and mental health conditions, as well as improve well-being, VA is embarking on a major health-care transformation. The Integrative Health Coordinating Center (IHCC) in VA’s Office of Patient-Centered Care and Cultural Transformation was established in 2014 to identify and address barriers to implementing CIH across VA and to serve as a resource for clinical best practices and education for veterans, staff, and leadership. An FY15 internal survey showed 93% of VA facilities offered at least 1 CIH approach. The most widely offered approaches were acupuncture, meditation, yoga and tai chi which are known to help with complex issues veterans face such as pain management and mental health conditions, as well as optimization of well-being. IHCC is building the infrastructure to support streamlined implementation of CIH across VA to include policy, tracking/billing mechanisms, new professions, clinical guidelines, access to CIH approaches through telehealth, and strategic partnerships. Guiding implementation are evidence maps, which provide a visual overview of the distribution of evidence for each approach, systematic reviews, and further research on outcomes. Supported by the Comprehensive Recovery and Addiction Act (CARA) legislation, VA has launched the Whole Health System (WHS) in 18 Flagship Facilities in FY18, the first wave in national deployment of more comprehensive CIH services. The WHS model will serve as a delivery system for bringing effective, evidence-based CIH approaches, and self-care strategies into the care plan of every veteran. This session will discuss steps IHCC has taken to build the infrastructure for comprehensive implementation of CIH across VA, describe barriers encountered, and share best practices and lessons learned. Rationale: The VA is unique in that it covers all aspects outlined in this year’s conference: research, education, clinical practice, and policy. The VA is the largest integrated health-care system in the United States. Policy that is implemented in VA often impacts other organizations. Lessons learned from the work VA has done in the area of CIH could help inform other hospitals and academic institutions. Objectives: The aim is to list 3 of the barriers to CIH implementation, and steps VA is taking to address them, understand how the WHS model is the delivery system for CIH at VA, and describe 2 best practices for implementation of CIH services from IHCC. (3612) Power of a Community-based Organizations and Academic Health Programs Working Together to Deliver Integrative Medicine: A Case Study Neile Edens, PhD1, Stephanie Folkens, BA2, Elaine Cheung, PhD2, Rupa Mahadevan, MD2 and Melinda Ring, MD, FACP2 1Common Threads, Chicago, Illinois 2Chicago, Illinois Abstract Overview: Background: Academic health programs and community-based organizations play complementary roles in delivering health care in underserved neighborhoods. Physicians/clinicians are authorities on treating illness and have the benefit of focused time with individual patients, while community-based organizations can deliver accessible, intensive wellness programs in a supportive group setting. Collaboration between academic health programs and community-based organizations is beneficial to both physicians shape and enhance program material and are a resource for faculty/student volunteers, while community-based organizations can amplify and reinforce wellness messages and offer unique learning environments for trainees. Program Description: One model of this type of collaboration is the Cooking Up Health: Docs and Kids in the Kitchen program, developed and implemented jointly by the Osher Center for Integrative Medicine at the Feinberg School of Medicine, Northwestern University, and Common Threads, a nonprofit organization that provides cooking and nutrition education to children and adults in underserved neighborhoods. The Cooking Up Health program provides culinary medicine education to first-year medical students, who then teach Common Threads classes to elementary school students. In this model, medical students practice health coaching skills and explore cultural and socioeconomic factors in behavior change, while elementary students benefit from receiving nutrition instruction from medical student role models. Evaluation of the pilot implementation of the program found benefits to medical students, the effect of the program on elementary students is under investigation. Key factors that supported success of this model were Common Threads established infrastructure for delivering programs in public schools and the commitment and support of Osher Center leadership. Conclusion: Residents in underserved neighborhoods and academic programs both benefit from collaborative programs linking integrative medicine and community-based organizations (supported by the Alliance for Research in the Chicagoland Communities). Rationale: Building community-based partnerships is integral for integrative medicine to flourish; it is one way to create sustainable change in the local community and partner with already established organizations to promote health and wellness. Partnering with community organizations can advance the education sector of integrative medicine and lifestyle medicine in meaningful ways for students from elementary school age to graduate level education. With the help of community-based organizations, our advocacy effort to build awareness for nutrition, healthy eating, and fighting childhood obesity has impacted Chicago Public School education as well as medical school students. Community partnerships can enhance community engagement in projects and bring attention to health topics in underserved areas. Objectives: By the end of this session, participants will be able to see how community partnerships can enhance education and how integrative medicine clinicians and trainees can impact on community health. Participants will learn how engagement with the community can positively impact health-care education, know how community partnerships can build greater awareness to fight current health epidemics, understand how health-care delivery can be enhanced through community partnerships, demonstrate how the medical establishment and community sector can create lasting change through advocacy efforts, and develop increased interest in finding a local community organization with whom to partner. (3618) Ketamine, Psychedelics, and MDMA: A New Path for Integrative Psychiatry Will Van Derveer, MD1 and Scott Shannon1 1▪▪ Abstract Overview: Psychiatry is currently at a cross roads. The chemical imbalance theory that has driven much of our conventional care over the last 30 years has been undercut by research that tells us that this model is overly simplistic and not consistent with emerging brain research. In the last 10 years, research on ketamine, MDMA, and psychedelics has exploded in the literature. All of these agents can highlight a model that employs intermittent medication use that catalyzes deeper change. Clinicians and researchers are now exploring medication-assisted psychotherapy that posits an inner healer and moves away from the chemical imbalance theory and the model of daily suppressive therapy to keep symptoms at bay. This session will highlight an interactive discussion with the audience to consider the current research base, the concept of an inner healer, and the role these agents may play in integrative medicine and psychiatry. Rationale: This session will explore how research in innovative areas can alter both conventional and integrative care. It also opens up all of conventional psychiatry to a sea change in which the internal ability to heal is highlighted over the current model of pathology and daily medication and management. The research with MDMA, psychedelics, and ketamine is often based on a model in which the medications act as catalysts for deeper change and shift in awareness. This is a collaborative model built on relationship and trust in the inner healer. In late August, MDMA-assisted psychotherapy for severe PTSD was awarded break through status by the Food and Drug Administration based on phase II research. Currently, phase III of this trial is about to begin and compassionate use of this medication in this model will likely begin next fall. Both Dr Shannon and Dr Van Derveer are involved in the MDMA study as principal investigator/study therapist and study physician/study therapist, respectively. Objectives: The aim is to evaluate the current trends and evolving research model in medication-assisted psychotherapy and brief discussion about the historical links to shamanism in this model; assess the current research base in MDMA and the upcoming phase III trial; analyze the current research base concerning psychedelic medications and the future directions for treatment; recall the overall status of ketamine research and the appreciate the movement toward ketamine-assisted psychotherapy; and as a large group openly assess the concerns, limitations, and potentials for this work. Outline: 1. Medication-assisted psychotherapy history, philosophical foundations, and current status 2. MDMA background, history, and current research. Upcoming phase III trial design and implications 3. Psychedelics medications brief history, review of work in neuroimaging, and implications of findings in the default mode network and clinical research 4. Ketamine review of current research, discuss mechanism, and explore the different existing styles of treatment 5. Large group discussion on the these topics, cued as needed by provocative questions (3638) So You Want to Start a Clinical Fellowship in Integrative Medicine? Lessons Learned From 2 Osher Centers for Integrative Medicine in Developing Programs Shelley Adler, PhD1, Nancy Heap, MSW, LCSW1, Anand Dhruva, MD1 and Melinda Ring, MD, FACP1 1Chicago, IL Abstract Overview: Integrative health (IH) is proposed as a possible solution for addressing America’s health-care crisis, including the spiraling cost, opioid addiction, and obesity epidemic. One important barrier to providing access to evidence-informed integrative care is a lack of physicians who have received quality training in integrative medicine and can become leaders within academic centers, government agencies, and community settings. The Accreditation Council for Graduate Medical Education currently accredits residencies and fellowships in the United States but not those offering IH training. Efforts to increase accountability and standardization of IH fellowships in recent years include the publication of proposed IH fellowship competencies as well as the establishment of a board exam by the American Board of Physician Specialties. The number of clinical IH fellowships approved by the American Board of Integrative Medicine as meeting criteria for training to be eligible to sit for the board exam is increasing each year. Despite growing opportunities, the demand from trainees and the need in our health-care system remains unmet. The majority of traditional on-site clinical fellowships accept only 1–2 applicants per year, and the primarily distance-based fellowships reach higher numbers of trainees but lack on-site clinical oversight of patient care. In order to foster the development of highly qualified IH clinicians, 2 Osher Centers for Integrative Medicine (Northwestern University and University of California, San Francisco) launched on-site fellowships within the past 3 years. This symposium will share a stepwise process and offer some practical suggestions for those interested in developing an IH fellowship or refining a currently existing program. Presenters share from their own recent experiences, discussing lessons learned and challenges ranging from funding to candidate selection, in order to help attendees determine the feasibility for beginning the process at their own institution. Faculty from existing fellowships is encouraged to attend to share additional perspectives. Rationale: The Congress and the Academic Consortium for Integrative Medicine and Health are driven by the mission of sharing information on education, research, and clinical fronts in order to foster the growth of integrative medicine within our academic institutions. Providing a road map for institutions interested in pursuing the development of a fellowship program is aligned with the goal of nurturing our future leaders. Objectives: This symposium is intended to serve as a blueprint for some essential components of a successful fellowship program, as well as a road map for effectively navigating the challenges faced in creating and sustaining one. After this symposium a participant will be able to describe the process of strategic planning for a fellowship; differentiate options for a curriculum that can be customized to meet the educational goals of an individual fellow; identify key components including core faculty, funding, space, and patient access needed to ensure program success; and assess the options for trainee recruitment in terms of numbers, specialties, and duration of training. Outline: Session speakers will discuss the following topics from the perspective of individual institutional experience that may serve as examples of lessons learned for attendees. 1. Strategic planning  • Curriculum development  • Self-study  • Teaching sessions  • Experiential sessions 3. Clinical training  • Fellow specialties and faculty expertise  • Patient flow and referrals  • Clinical teaching models 4. Selecting fellows  • Number of fellows  • Fellow qualifications  • Recruitment of fellows (3663) FOODCARE: Developing Evidence-based Clean Foods for Health and Disease Prevention in Pediatric Patients Maria Hanna, MS, RD, LDN1, Amy Dean, MPH, RD1, Alexandra Zeitz, BS2, Ben Fulton, BS2, Jessi Erlichman, MPH3, Jonathan Deutsch, PhD2 and Maria Mascarenhas, MBBS3 1The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 2Drexel University, Philadelphia, Pennsylvania 3Philadelphia, Pennsylvania Abstract Overview: Nutrition plays an important role in health and disease with increasing evidence linking eating patterns to chronic disease. Pediatrics provides a unique opportunity for disease prevention through nutrition education and provision of “clean” or whole foods (natural, organic, non-GMO, locally grown, nutrient rich, preservative, and pesticide free) from an early age. Food product development is typically based on market opportunities related to taste, convenience, cost, preparation time, shelf life, cultural preferences, and nutrition. There is a growing demand from the public for whole foods with low environmental impact. At the Children’s Hospital of Philadelphia (CHOP), we take a “food as medicine” approach in an effort to prevent and manage chronic conditions. We have requests from families for affordable whole foods that involve simple meal preparation and have partnered with the Food Lab at Drexel University’s Center for Food and Hospitality Management for recipe development. After discussion, based on patient, parent, and clinician requests, food ideas are ranked. The Drexel team then develops the recipe and tests it in their Food Lab. Taste testing occurs at Drexel and by registered dietitians at CHOP. Based on feedback, the finalized recipe is developed for dissemination. Initial recipes include a clean rehydration solution that can be made at home as well as a series of recipes that can be used for patients with constipation. The recipes are platform agnostic in that they can be provided as education to parents, produced by health-care food service providers on patient trays or in cafeterias, used in clinical research, or manufactured by start-ups or established food companies. Innovative partnership between clinicians and food science experts results in the production of evidence-based, healthy, easy to use food recipes for clinical use. FOODCARE creates clinically needed evidence-based food recipes by working backward through the typical food product development cycle. (3692) Stakeholder-informed Addition of Spices and Herbs Increased Vegetable Intake in the National School Lunch Program at an Underserved and Predominantly African-American High School Patrick F McArdle, PhD1, Mary K Bahr-Robertson, BA1, Brian M Berman, MD1, Christopher R D'Adamo1, Brandin Bowden, MS2, Elizabeth A Parker, PhD, RD1 and Ariel Trilling, BS1 1University of Maryland School of Medicine, Baltimore, Maryland 2The Institute for Integrative Health, Baltimore, Maryland Abstract Purpose: The National School Lunch Program (NSLP) serves over 5 billion school meals per year and helps surmount many barriers to healthy eating among underserved children and adolescents. However, vegetable intake in the NSLP remains strikingly low among underserved African-American high school students. The purpose of this study was to evaluate whether addition of stakeholder-informed vegetable recipes flavored with spices and herbs to the NSLP at an underserved and predominantly African-American high school in Baltimore, MD, would increase vegetable intake as compared to typical NSLP vegetable recipes. Results: A total of 4285 plates (typical: n = 2160, spiced: n = 2125) were collected from students over 8 weeks for assessment of vegetable intake. There was a 21% increase in total vegetable intake when spiced compared to typical (0.33-ounce increase, P < .0001). Vegetables with the largest increases when spiced compared to typical recipes were carrots, broccoli, and vegetable medley (broccoli, carrots, cauliflower). Conclusions: Adding student-tested vegetable recipes flavored with spices and herbs to the NSLP and evaluating vegetable intake was feasible at an underserved and predominantly African-American high school in Baltimore. Extensive stakeholder engagement facilitated one of the largest school-based vegetable intake studies conducted to date. While additional interventions are needed to further engage students in dietary improvements, addition of spices and herbs provides a resource-efficient means of achieving modest increases in vegetable intake among this challenging demographic. (3696) Culinary Medicine: Lessons Learned From Implementing Curricula Across the Country Rupa Mahadevan, MD Amy Locke, MD1, Melinda Ring, MD2, Misha Kogan, MD, Sonia Oyola, MD, Geeta Maker-Clark, MD and Seema Kakar MD3 1Salt Lake City, Utah 2Osher Collaborative for Integrative Medicine, Chicago, Illinois 3Washington, DC Abstract Overview: Medical school nutrition curricula have struggled to provide the needed skills for assisting patients with health behavior change, despite a strong societal need for guidance in this area. Culinary Medicine is a unique approach to helping physicians improve the lives of their patients while also impacting their own wellness. Challenges include access to a teaching kitchen, suitable faculty knowledge, implementing interprofessional education, and funding. University of Utah Health (UUH) developed a Culinary Medicine program with the School of Medicine (SOM) and the College of Health (COH) using the Goldring Center for Culinary Medicine at Tulane University curriculum in 2016. In 2017, this elective was expanded to students from the COH and School of Pharmacy using curriculum designed and taught by UUH faculty. The Culinary Medicine program at Pritzker School of Medicine is offered as part of the curriculum for all students rotating through Family Medicine and as an 8 week optional elective for M1 students taught by physicians and a chef/dietitian. The program has recently expanded to include community outreach in the South Side of Chicago, at Blackstone Bikes and the Montessori School of Englewood. Osher Center for Integrative Medicine at Northwestern University received a grant to cocreate a Culinary Medicine curriculum in partnership with Common Treads, an organization which is experienced in delivering cooking and nutrition education in schools and other youth program sites in Chicago and across the country. The first student cohort participated in 2017. Georgetown School of Medicine launched its Culinary Medicine elective in the fall of 2017 in collaboration with Capital Food Bank who supplied the space. These evidence-based, nutrition curricula are examples of innovative strategies to foster appreciation for nutrition in prevention and management of disease. This panel discussion will highlight the different curricula along with the challenges and successes in implementation. Rationale: Nutrition knowledge, food choices, and healthy cooking habits have been shown to play a significant role in the prevention and management of obesity and its related diseases. Yet primary care residents and practicing physicians feel unprepared to counsel their patients about important elements of lifestyle such as nutrition and exercise. A third of Americans are obese and nearly two thirds are overweight; the negative sequelae of obesity and its comorbidities cost the U.S. roughly $190 billion annually. Culinary Medicine is a new approach to teach health-care professionals the necessary skills to affect behavior change with patients. Implementation of curricula has been slow to reach students despite interest due to difficulties operationalizing this program on a large scale. The purpose of our presentation is to highlight the importance of this type of interactive, interdisciplinary education while exploring the steps, barriers, successes of starting this type of nutrition curriculum at different schools of medicine. Objectives: The aim is to define culinary medicine and describe the role it can play in training students and residents to assess patients’ habits and provide assistance in lifestyle modification, identify strategies for implementation and solutions to common challenges of culinary medicine curriculum into health sciences education, and articulate the role of culinary medicine in the personal wellness of health-care providers. Outline: Participants will be involved in an interactive discussion with the faculty/panelists representing the University of Utah, Chicago Pritzker School of Medicine, Osher Center for Integrative Medicine at Northwestern University and Georgetown University after short presentations where each faculty describes a short history of the program, current impact of the work on either medical students, community member or both, challenges regarding sustainability and future outlook. Throughout the postpresentation question and answer session, participants will have the opportunity to discuss related educational examples of innovative medical student education in their own settings. Participants will also be encouraged to consider the benefits of and barriers to incorporating educational programs for training medical students to address nutrition with patients. (3704) Exploring Interprofessional Integrative Clinical Care Sonia Sosa, MD1 1▪▪ Abstract Overview: Oregon Health and Science University (OHSU) Richmond clinic opened in 1995 and became a Federally Qualified Look Alike in 2004. In 2012, it became a full Federally Qualified Health Center (FQHC). We serve a primarily Medicaid, Medicare, and uninsured population with a service area which compromises a population of greater than 50 000 people which is both ethnically and socially diverse. In 2015, OHSU and the Naturopathic University of Natural Medicine (NUNM) decided to join forces and create an Interprofessional Integrative Medicine Consult Clinic within Richmond clinic. Richmond clinic has a model for offering specialty consult clinic sessions to provide patients who are having difficulty being seen in outside specialty clinics a specialist visit within their primary care medical home. We offer these consult clinics for cardiology, ENT, pain, sport’s medicine, podiatry, and orthopedics. We sought to develop an integrative medicine consult clinic in this model. The goal of the Interprofessional Integrative Medicine consult clinic was to bring together allopathic medical students, Family medicine residents and attendings, naturopathic residents and attendings, behavioral health, clinical pharmacists, and RNs in the care of our often complex and challenging patients. We aim to offer an Integrative Approach to Richmond’s patient population who otherwise often find it challenging to acquire nonallopathic approaches to care. We also intend to increase interprofessional collaboration between our students, residents, and staff and hope to create a care model that improves both the patient and provider experience. This presentation will discuss our process for developing this clinic, what we have learned since the clinic was started, patient and provider reactions, interprofessional collaboration strategies, our evaluative process, and future goals for the clinic and for interprofessional integrative medicine at our institutions. Rationale: This consultative clinic provides a novel example of an interprofessional and integrative clinical care model. In an era in which the importance of interprofessional collaboration is gaining recognition, it is imperative that we explore models of care in which there is true collaborative care. This session explains the logistics of an integrative interprofessional clinic, its benefits, and challenges. It provides a replicable model of care which can be used in other academic and FQHC settings. In addition, we will begin to explore further areas of research. Objectives: The aim is to explore the development process of an interprofessional integrative medicine consult clinic within an FQHC and academic medical center including how to involve naturopathic providers in an allopathic setting, examine best strategies for promoting interprofessional collaboration in clinical care, describe our experience with an Interprofessional Integrative Medicine consult clinic, review evaluative strategies for an innovative clinic model, and discuss future goals and further collaborative efforts. (3707) Brain Mechanisms Underlying Symptom Improvement in Chronic Visceral Pain After Mindfulness Training Cody Ashe-McNalley, MS1, Jean Stains, RN, Suzanne Smith, NP2, Greg Serpa, PhD3, Bruce Naliboff, PhD, Lisa Kilpatrick, PhD2, Ravi Bhatt, PhD1, Jennifer Labus, PhD, Annie Gupta, PhD2 and Kirsten Tillisch, MD1 1University of California, Los Angeles, Los Angeles, California 2Los Angeles, California 3Greater Los Angeles VA, Los Angeles, California Abstract Purpose: Background: Irritable bowel syndrome (IBS) is a brain-gut disorder characterized by abdominal pain associated with altered bowel habits which responds well to mind–body interventions, such as hypnosis, cognitive behavioral therapy, and mindfulness-based stress reduction (MBSR). Aims: To determine symptom-related changes in resting state network connectivity (RS-FC) in patients with IBS after an MBSR intervention. Results: A total of 63 participants (47 women; mean age, 33 ± 9.8 years; age range, 19–54 years) completed the MBSR training and scans. Treatment-related improvement in IBS severity scoring system (IBS-SSS) was observed (mean improvement, 74.8 points, P < .001), which was significantly correlated with treatment-related improvement in MAAS (r = .27, P = .039). IBS-SSS improvement was significantly correlated with treatment-related decreases in the connectivity strength of the left amygdala (r = .39, P = .002, q = .039), right subcentral gyrus (r = .30, P = .016, q = .15), and left suborbital gyrus/sulcus (medial prefrontal cortex; r = .37, P = .003, q = .039), and with treatment-related decreases in the eigenvector centrality of the left suborbital gyrus/sulcus (r = .38, P = .002, q = .039). Treatment-related decrease in the connectivity strength of the left suborbital gyrus/sulcus was also correlated with improvements in MAAS (r = .036, P = .004). Conclusions: IBS patients undergoing an MBSR intervention have improvements in mindfulness and overall IBS symptoms, which are associated with decreases in the strength and centrality of emotional processing, somatosensory, and salience brain regions. (3765) Electroacupuncture-induced Analgesia in an Animal Model of Complex Regional Pain Syndrome Type 1: Evaluation of Peripheral Endothelinergic Receptors Francisco Cidral-Filho, PhD1, Afonso Salgado, PhD1, Daniel F Martins, PhD1, Leidiane Mazzardo-Martins, PhD2, Júlia Koerich3, Kamilla Pamplona1, Luiz A Belmonte, PhD1, Ari Moré, PhD3, Verônica V Horewicz, PhD1, Anna Paula Piovezan, PhD1, Daniela D Lüdtke, PhD1, Elisa C Winkelmann Duarte, PhD2 and Daiana C Salm2 1University of Southern Santa Catarina, Palhoça, Brazil 2University of Federal of Santa Catarina, Florianópolis, Brazil 3Universitary Hospital, Florianópolis, Brazil Abstract Purpose: To evaluate the possible antihyperalgesic effect of electroacupuncture (EA) in a model of complex regional pain syndrome type 1 (CRPS-I) as well as the involvement of endothelinic ETB receptors in this effect. Results: I/R induced marked and long-lasting mechanical hyperalgesia. EA reduced mechanical hyperalgesia on all treatment days (days 3 to 21 post I/R), with effects lasting for up to 1-h post treatment (P < .05–.001). Sarafotoxin (i.pl., 10 μL) decrease mechanical nociception induced by I/C with effect prevented by 15 min prior administration with Bq-788 (i.pl., 10 μL). Pretreatment with Bq-788 (i.pl., 10 μL, 15 min prior) prevented the antihyperalgesic effect of EA. EA and sarafotoxin (i.pl., 10 μL) treatment combination induced 2-h analgesia, which is twice longer than each separate treatment (1-h analgesia). Conclusions: EA induced analgesia is dependent upon peripheral endothelinergic receptors activation in an animal model of CRPS-I. (3778) Clinical Nutrition for Doctors-in-Training: Reflections and Challenges of Incorporating Nutrition Education Into Medical School Curricula Mary P Smith, BA1, Catherine Crawford, BA1 and Raymond Teets, MD1 1New York, New York Abstract Overview/Background: Effective lifestyle management, including nutrition education, is an invaluable component of integrative health-care management. In practice, however, few physicians feel comfortable addressing the nutritional aspects of diseases. What’s more, nutrition education is underrepresented at many medical schools, with most recent surveys showing that only 25% of programs in the United States require nutrition education. Program Description: We created and implemented the clinical nutrition for doctors in training course to fill this gap by supplementing the standard medical curriculum at the Icahn School of Medicine with instruction about clinical nutrition. Our goal is to improve medical students’ competence regarding their own health behaviors and to provide training for incorporating nutritional management into patient care. The course was designed in Fall 2016 in collaboration with the Students for Integrative Medicine Group and the Mount Sinai Hospital Clinical Nutrition Department as a 7-week extracurricular learning experience. To receive credit, students are required to attend 4 of the 7 sessions. By completion, students will be able to differentiate the role of inpatient and outpatient dietary specialists, better understand typical diets consumed by patients, and counsel patients about dietary modification within the context of their health and social needs. Conclusion: Since Fall 2016, 5 participants completed the program. In postcurriculum surveys, all participants reported improved confidence in their ability to counsel patients on proper dietary habits in the context of diabetes, heart disease, and chronic kidney disease. As a result of feedback, the Office of Medical Education is incorporating themes from the sessions into the standard medical curriculum. This will improve student understanding of how disease progression can be slowed, stopped, or reversed by diet. In this way, the rising generation of medical professionals will be better trained to improve patient outcomes through diet, an increasingly meaningful component of integrative health-care management. Rationale: Providers who understand the impact of diet on disease states and who can effectively counsel patients with regard to dietary needs can offer a more integrative approach to addressing their patient’s health. Nevertheless, nutrition education is conspicuously absent from most undergraduate medical curricula across the United States, with most recent studies showing that only 25% of U.S. medical programs require nutrition education.1 We believe that this is a gross oversight given the current health-care landscape within the United States: per the Centers for Disease Control and Prevention’s latest reports, 30.3 million individuals (9.4% of the population) currently live with diabetes in the United States; more that 610 000 individuals die of heart disease each year; approximately 75 million (1 in 3) adults in the United States live with high blood pressure. These statistics are staggering, and not enough is being done to educate physicians about how to treat their patients with dietary and lifestyle modification. What's more, a 2008 study that surveyed a random sample of internal medicine residents across the country showed that while 77% agreed that nutrition assessment should be included in routine primary care visits, and 94% agreed that it was their obligation to discuss nutrition with patients, only 14% felt physicians were adequately trained to provide nutrition counseling. With our clinical nutrition for doctors in training curriculum, we strive to meet this need by providing the next generation of medical professionals with the tools to better advise and motivate patients with regard to nutrition. Objectives: By the completion of this course, participants will understand the differences in the role of an inpatient and an outpatient dietitian/nutrition specialist; be able to make better decisions about their own nutrition within the context of our current lifestyle (medical students) and community (East Harlem/Upper East Side); have a better understanding of the typical diets consumed by our patients, and how that is influenced by the availability and cost of food in this community; give advice regarding how to modify traditional meals so as to improve health but not sacrifice taste and tradition; have a better understanding of the practice of “mindful eating,” and how that can translate into a healthier body and environment; learn about various “lifestyle diets” defined as dietary restrictions resulting from a patient’s taste preferences, ethical convictions, environmental stances, or religious observations; gain an understanding of how the progression of certain diseases can be slowed, stopped, or in some scenarios, reversed by diet; have gained experience interviewing and engaging patients about maintaining healthy diets, especially in the context of dietary restrictions or clinical conditions; and learn more about how to incorporate integrative medicine practices and education into their medical school curriculum. (3779) Comparative Effectiveness of Tai Chi Versus Aerobic Exercise for Fibromyalgia: A Randomized Controlled Trial Chenchen Wang, MD, MSc1, Jeffrey B Driban, PhD, ATC, CSCS1, William F Harvey, MD, MSc1, Lori L Price, MAS, MLA2, Timothy E McAlindon, MD, MPH1, Christopher H Schmid, PhD3, Roger A Fielding, PhD4, Kieran F Reid, PhD, MPH4, Ramel Rones5 and Robert A Kalish, MD1 1Tufts Medical Center, Boston, Massachusetts 2Tufts University, Boston, Massachusetts 3Brown University, Providence, Rhode Island 4Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, Massachusetts 5Center for Mind-Body Therapies, Boston, Massachusetts Abstract Purpose: Fibromyalgia is a complex disorder with psychological and pain components. Tai Chi (TC), an integrated mind–body approach, has potential in treating fibromyalgia. It is unknown whether TC is more effective than aerobic exercise, a common treatment for fibromyalgia, and if its effectiveness depends on dosage and duration. Results: We included 226 subjects (mean age = 52 ± 12, duration of pain = 9 ± 8 years, body mass index = 30.0 ± 6.7 kg/m2, 92% women, 61% white). The average of 4 TC groups, compared to aerobic exercise, showed significant improvements in Revised Fibromyalgia Impact Questionnaire (FIQR; P = .03), patient global (P = .005), anxiety (P = .006), and self-efficacy (P = .0004). All other secondary outcomes favored TC over aerobic exercise at 12, 24, and 52 weeks. Twenty-four-week TC groups achieved significant improvements in FIQR, depression, and mental-component scores compared to 12-week groups (Table 1). TC with the same dosage and duration as aerobic exercise demonstrated an even larger effect for FIQR (16.2 points, 95% confidence interval: 8.7, 23.6; P < .0001). TC effects were consistent across instructors. Conclusions: TC results in similar or greater symptom improvement than aerobic exercise, and longer duration demonstrated greater improvement. (3782) Effects of Meditation and Music-listening on Blood Biomarkers of Cellular Aging and Alzheimer’s Disease in Adults With Preclinical Memory Loss: An exploratory Randomized Controlled Trial Dharma S Khalsa, MD1, Hannah Bowles, MS2, Zenzi Huysmans, MS3, Sahiti Kandati, MPH, DDS4, Caitlin Montgomery, MPH4, Terry K Selfe, DC, PhD5 and Kim Innes, PhD, MSPH4 1Albuquerque, New Mexico 2School of Medicine, West Virginia University, Morgantown, West Virginia 3College of Physical Activity and Sport Sciences, West Virginia University, Morgantown, West Virginia 4School of Public Health, West Virginia University, Morgantown, West Virginia 5University of Florida, Gainesville, Florida Abstract Purpose: Telomere length (TL), telomerase activity (TA), and plasma beta-amyloid (Aβ) levels have emerged as possible predictors of cognitive decline and dementia, and as potential targets for intervention. In this pilot randomized controlled trial, we assess (1) the effects of two 12-week relaxation programs on TL, TA, and plasma Aβ in older adults with subjective cognitive decline and (2) the relationship of changes in these biomarkers to improvements in cognitive function, psychosocial status, and quality of life (QOL). Results: Baseline blood samples were available for 53 participants (25 KK, 28 ML). Both KK and ML groups showed increases in TA, although changes were significant only among those above the 30th centile in practice adherence. Changes in TL and TA varied by baseline values of these markers, with greater increases among participants with respective values ≤50th centile (P’s for interaction <.006). The ML group showed significantly greater declines in Aβ40 than did the KK group and greater increases in Aβ42/40 ratio. Both groups improved significantly in memory, cognitive function, and psychosocial status (P’s ≤.05), with improvements in stress, mood, and QOL greater in the KK group (P’s ≤ .08). Increases in plasma Aβ levels were significantly correlated with improvements in cognitive function, mood, stress, sleep, and QOL at both 3 and 6 months; these relationships were particularly pronounced in the KK group. Increases in TL and TA were also significantly associated with improvements in certain measures of psychosocial status and cognitive function. Conclusions: Practice of simple mind–body therapies may alter plasma Aβ levels, TL, and TA. Increases in these biomarkers were associated with improvements in cognitive function, sleep, mood, and QOL, suggesting a possible functional relationship. (3788) Interoception, Meditation, and Pain Sahib Khalsa, MD, PhD1, Wen G. Chen, MMSc, PhD2, Cynthia J Price3, Stephen Liberles, PhD4 and Jennifer S. Labus, PhD5 1University of Tulsa, Tulsa, Oklahoma 2National Center for Complementary and Integrative Health, Bethesda, Maryland 3University of Washington, Seattle, Washington 4Harvard Medical School, Boston, Massachusetts 5David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California Abstract Overview: The ability of the brain to consciously sense the physiological state of the body, including the cardiorespiratory system, gastrointestinal system, nociceptive system, and endocrine and immune system, has commonly defined the sensory process called interoception. Meditative practices often employ techniques to heighten and enhance the interoceptive experience. In addition, mindfulness meditation has been shown to benefit pain relief in patients with chronic pain. A recent body of research has begun to examine the mechanisms underlying the interoceptive experience of meditative practices as well as the impact of meditative practices on nociceptive processing. This symposium will bring some of the leaders in the fields of interoception, meditation, and pain together to discuss cutting-edge findings and explore the potential connections among interoception, meditation, and possibly pain. Dr Cynthia Price from University of Washington, a National Center for Complementary and Integrative Health (NCCIH) advisory council member, will first present recent advances on the relationships among interoception, meditation, and emotional regulation in clinical care. Dr Sahib S. Khalsa, director of clinical studies at the Laureate Institute for Brain Research, will then present current research on the neural mechanisms of interoception from human studies. Next, Dr Stephen Liberles at Harvard Medical School, who has pioneered some of the most influential work on the molecular and neural circuitry mechanisms underlying interoception in animal models, will present his current theory and research on the mechanisms of interoception. Lastly, Dr Jennifer Labus from the University of California at Los Angeles will present and discuss recent findings from the Pain and Interoception Imaging Network. The session will conclude with a question/answer and discussion period moderated by Dr Wen Chen from NCCIH. Rationale: The ability of the brain to consciously sense the physiological state of the body, including the cardiorespiratory system, gastrointestinal system, nociceptive system, and endocrine and immune system, has commonly defined the sensory process called interoception. Meditative practices commonly employ techniques to heighten and enhance the interoceptive experience. In addition, mindfulness meditation has been shown to benefit pain relief in patients with chronic pain. Recent scientific research advances began to examine the mechanisms underlying the interoceptive experience of meditative practices as well as the impact of meditative practices on pain. This symposium will bring some of the leaders in the fields of interoception, meditation, and pain together to discuss cutting-edge findings and to explore the potential connections among interoception, meditation, and possibly pain. A better understanding of these interconnections may facilitate the development of more effective complementary therapies to address some of the most challenging medical conditions of the current time. Objectives: As a result of attending this session, participants will be able to (1) describe current and cutting-edge scientific research on interoception, meditation, and chronic pain; (2) discuss the importance of interoception research for improving our understanding of mind and body interventions and their potential clinical benefits; and (3) promote a dialogue about promising future research directions on interoception and its impact on health. Outline: • What is the current scientific evidence on how brain detects and processes interoceptive sensation? • What is the current scientific evidence on how meditative practices utilize and modulate interoceptive experience? • Are there any common brain regions or neural networks involved in pain experience, interoceptive sensation, and mindfulness meditation? • How can understanding interoception at the molecular and neural circuitry levels help optimize the beneficial effects of mindfulness meditation? • Is the experience of pain a form of interoceptive awareness, and if so, how can meditation help to manage conditions marked by chronic pain or interoceptive dysregulation? (3792) Utilization of Neuroimaging and Neurofeedback to Treat Chemotherapy-induced Peripheral Neuropathy—Results of a Randomized Controlled Trial Gabriel Lopez, MD1, Lorenzo Cohen, PhD1, Sarah Prinsloo, PhD1, Randall Lyle, PhD1, Larry Driver, MD1, Diane Novy, PhD1, Lois Ramondetta, MD1 and Cathy Eng, MD1 1Houston, Texas Abstract Purpose: We examined neurophysiological correlates and patient-reported outcomes of chemotherapy-induced peripheral neuropathy (CIPN) to understand CIPN as it relates directly to brain activity. We used a brain training paradigm, neurofeedback (NF), to teach patients to modify brain activity to alleviate symptoms of CIPN. Results: Eighty-three percent of participants demonstrated similar EEG patterns, which was significantly related to improvement in symptoms after NF. 100% of participants who started NF completed treatment. NF lead to significant reduction in neuropathic symptoms such as pain and numbness (previously reported), and in cancer-related symptom interference (NF = −5.3 vs WL = −0.5, P = .000); symptom severity (NF = −5.1 vs WL = −0.8, P = .000), fatigue (NF = −3.7 vs WL = −0.8, P = .001), and sleep disturbances (NF = −2.3 vs WL = 0.8, P = .030); and improved physical functioning (NF = 3.3 vs WL = 1.4, P = .003). At 4 months, the outcomes remained for targeted symptoms. Conclusions: CIPN may have distinct electrophysiological correlates. NF clinically and significantly improved primary outcomes at 4 months posttreatment and reduced secondary symptoms associated with CIPN. Figure 1. Typical map of database comparisons of electrophysiological activity in CIPN patients. CIPN, chemotherapy-induced peripheral neuropathy. (3799) Controlled Trial Evaluating the Addition of Chiropractic Care to Medical Care for Patients With Low Back Pain Joan Walter, JD, PA1, Katherine A Pohlman, DC, MS2, Robert D Vining, DC3, Christine M Goertz, DC, PhD Cynthia R Long, PhD and Ian D Coulter, PhD4 1Samueli Institute for Information Biology, Silver Spring, Maryland 2Parker University, Dallas, Texas 3Palmer College of Chiropractic, Davenport, Iowa 4RAND Corporation, Santa Monica, California Abstract Purpose: There is a critical need to evaluate the impact of nonpharmacological treatments for low back pain (LBP) and associated disability. This trial determined whether the addition of chiropractic care to usual medical care (UMC) in patients with LBP resulted in better pain relief, pain-related function, patient satisfaction, and perceived benefit after 6 weeks when compared to UMC alone. Results: Mean participant age was 31 years, 23% were female and 32% were nonwhite. Thirty-eight percent of participants reported acute LBP, 11% subacute, and 51% chronic. Statistically significant site-by-time-by-group interactions were found in all models, so results are reported by site. Adjusted mean differences in outcomes at week 6 were statistically significant in favor of UMC plus chiropractic care at each site for LBP intensity (site 1: 0.7, site 2: 1.2, and site 3: 1.3), disability (1.7, 2.1, and 2.7), perceived improvement, and satisfaction. There were no significant differences in pain medication use. No serious adverse events related to treatment were reported. Conclusions: Chiropractic care, when added to UMC, resulted in short-term improvements in LBP intensity and disability, demonstrated a low risk of harms, high patient satisfaction, and perceived improvement. This trial supports the inclusion of chiropractic care as an effective component of a multidisciplinary approach for LBP, consistent with newly released guideline recommendations. (3800) Customizing Integrative Oncology for Adolescent and Young Adults With Cancer Douglas McDaniel, MTOM, Dipl Ac (NCCAOM), LAc1, Leigh Leibel2 and Lynda Beaupin, MD1 1Roswell Park Cancer Institute, Buffalo, New York 2New York, New York Abstract Overview: This interactive workshop will focus on personalizing integrative therapies for unique adolescent and young adult cancer scenarios. Integrative techniques for neuropathy, psychologic distress, and sexual health challenges will be highlighted. We will discuss implementing these practices in different clinical structures, and how adaptive these therapies are across the cancer care continuum, from diagnosis and through survivorship. Rationale: Adolescent and young adults (AYAs) are a unique subset of oncology patients whom the National Cancer Institute identifies as those between 15 and 39 years of age. Cancer types across this age spectrum vary widely and include Hodgkin Lymphoma, thyroid cancers, sarcomas, and breast cancer. AYAs may experience treatment side effects that differ from the pediatric and older adult populations and are at higher risk of infertility from their cancer treatment. AYAs also face a myriad of psychosocial challenges ranging from emotional to financial that occur during a critical period in human development, when young people are becoming more independent, establishing relationships and careers, exploring their sexuality, and forming their own worldview. Though we have learned more about the AYA population over the past decade, very little progress has been made to effectively address their issues. Integrative medicine has a role in cancer care for all patients. For AYAs, integrative modalities may be particularly attractive due to their accessibility and affordability. Meditation, yoga, and acupuncture are common practices that have been shown to alleviate treatment side effects; reduce symptoms of stress, anxiety, and depression; and improve quality of life scores. These interventions are adaptable across a range of age groups, treatment stages, demographics, and diagnoses seen among AYAs. Through a panel discussion, we will highlight where the research in this area is headed, what opportunities exist for clinician education, and how this relates to clinical practice. Integrative medicine practice in AYA oncology is a true collaboration in action! Objectives: After attending this session, it is expected that the attendee will be able to provide an overview of the challenges AYA cancer patients face during and after a cancer diagnosis; describe the application of various integrative medicine techniques for side effects, psychosocial issues, infertility, and sexual health concerns; understand how to integrate complementary therapies into AYA cancer care; and develop strategies to personalize integrative therapies for AYAs. Outline: Format of workshop The workshop will consist: - Brief background lecture - Interactive case discussions and demonstration - Panel discussion where participants will be welcomed to share challenging scenarios in their practice (3801) Efficacy of Systolic Extinction Training in Reducing Pain and Interference in Female Fibromyalgia Patients Who Respond to Stress With Elevated Blood Pressure Kati Thieme, PhD1 1University of Marburg, Marburg, Germany Abstract Purpose: An intrinsic pain regulatory system is both modulated by cardiovascular dynamics that influence baroreflex sensitivity (BRS) and diminished in fibromyalgia (FM). Baroreceptors relay cardiovascular output to the dorsal medial nucleus tractus solitarius reflex arcs that regulate pain, sleep, anxiety, and blood pressure. This study evaluated the effects of systolic extinction training (SET) that combines operant treatment (OT) with baroreflex training (BRT). BRT delivers peripheral electrical stimulation immediately after systolic or diastolic peak of the cardiac cycle. This treatment is compared to (1) OT-TENS, transcutaneous electrical stimulation independent of cardiac cycle, and (2) aerobic training (AT)-BRT in FM patients with elevated blood pressure stress responses. Results: In contrast to OT-TENS and AT-BRT, patients receiving SET reported a significant greater reduction in pain and interference (all Ps <.01) that were maintained at 6- to 12-month follow-up. Significant clinically pain reduction at T3 was reached in 82% of SET, 39% of OT-TENS, and 14% of AT-BRT-treated patients. After SET, compared to OT-TENS and AT-BRT, BRS increased 57% (Ps < .01). Conclusions: SET resulted in significant and long-lasting pain remission and interference compared to the OT-TENS and AT-BRT groups, suggesting that BRS modification was the treatment outcome mechanism. Additional research with larger samples and other chronic pain conditions appears to be warranted to confirm and extend the results. (3848) Aromatherapy, Acupressure, and Breathing to Balance for Kids Kathleen S Farah, MD1, Maura Fitzgerald, APRN2 and Melanie Brown, MD2 1Minneapolis, Minnesota 2Children’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota Abstract Overview: This is an experiential workshop designed for the participants to leave with tools they can use upon return to their practice and with their own families. The copresenters have extensive experience in using these skills at Children’s Minnesota and in populations of various backgrounds in the community. Evidence-based use of aromatherapy will be introduced, with opportunity to try out those we find most useful for common symptoms such as nausea, pain, anxiety, and sleep issues. Acupressure is a child and teen friendly alternative to acupuncture, and the participant will gain an understanding of easy to use acupressure points. How to teach breathing to kids and teens of various ages will be introduced, using fun props. The importance of these skills to balancing the nervous system will be reviewed. We look forward to sharing our knowledge and experience with the participants. Rationale: Interest in integrative medicine is increasing in popularity and significance across the United States and globe. Practitioners and families are looking for practical alternatives to pharmaceuticals for their children. This experiential workshop will focus on 3 key skills that have been widely and successfully used by the presenters at Children’s Minnesota, in both the inpatient and outpatient settings. This workshop will provide evidence-based background combined with practical skills. We have chosen to focus on these 3 areas to allow ample time for the experience. Aromatherapy is easy to use and a great tool for common symptoms such as pain, anxiety, nausea, and insomnia. Acupressure is a wonderful self-help tool and easily learned by practitioners and parents. Breathing to relax is the basis of many relaxation skills and is easily taught to children of many ages and cultures. The participants will find these skills helpful personally and professionally. Objectives: The aim is to understand the use of aromatherapy in the pediatric population for common symptoms, to understand the use of acupressure for common pediatric symptoms; understand how breathing is of use in balancing the nervous system (stress response) and learn how to teach to children of all ages; and review the literature supporting the safe use of aromatherapy, acupressure, and diaphragmatic breathing. Outline: Introduction—Why is integrative medicine important for children, their care givers, and their practitioner? 1. Aromatherapy  a. Brief history of aromatherapy  b. Sources of essential oils and methods of application  c. Selected research and research challenges.  c. Essential oils and pediatrics—common essential oils, safety, and management of symptoms such as anxiety, nausea, pain, and poor sleep. 2. Acupressure/acupuncture  a. Brief background on how acupuncture/acupressure works  b. Teach acupressure points that are useful for common symptoms such as headache, pain, and nausea  c. Selected research and research challenges 3. Breathing  a. Review of the autonomic nervous system, stress responses, and the importance of breath in the body.  b. Teach several breathing techniques in child friendly ways using props such as bubbles and pinwheel  c. Selected research using breath and breath-based skills (3851) State of Complementary and Integrative Health Policy, Use, and Delivery in the VA Ben Kligler, MD1, A Rani Elwy, PhD1, Steve Zeliadt, PhD1, Princess Osei-Bonsu, PhD1, Katherine Hoggatt, PhD1, Karleen Giannitrapani, PhD1, Stephanie L Taylor, PhD, MPH2, Alison M Whitehead, MPH3, Melissa M Farmer, PhD, MS2, Uyi Igodan, MPA4, Barbara G Bokhour, PhD5 and Michael G. McGowan, MA5 1Palo Alto, California 2VA Greater Los Angeles Healthcare System, Los Angeles, California 3Washington, DC 4VA Greater Los Angeles Healthcare System, North Hills, California 5Los Angeles, California Abstract Overview: The Veterans Health Administration (VHA), the nation’s largest integrated health-care system, is at the forefront of providing complementary and integrative health (CIH) approaches, with 93% of VHA medical centers providing 2+ CIH approaches in 2015. The Integrative Health Coordinating Center (IHCC) within the VA’s Office of Patient-Centered Care and Cultural Transformation formed 2014 to identify and address barriers to providing CIH and to serve as a resource across the VA. Partially in response to the 2016 Comprehensive Recovery and Addiction Act (CARA) legislation, the IHCC is leading a major expansion of CIH provision. Through the VA Quality Enhancement Research Initiative Complementary and Integrative Health Evaluation Center (CIHEC), the IHCC and VA health services researchers are collaborating to evaluate the effectiveness and implementation of CIH. We will review 6 activities and results of this VA IHCC/health service research collaboration. 1. Overview of IHCC’s efforts—Late 2017, the VA launched the first wave of a national deployment of expanded CIH approaches in a “Whole Health System” effort in 18 VA medical care centers. 2. “18 in 18” Whole Health Evaluation—We are evaluating the implementation and effectiveness of the Whole Health components, one of which is CIH, at 18 VA medical centers. 3. CIHEC Environmental Scan of CIH Provision at the VA—In August–September 2017, we conducted a survey of CIH program leaders at all VA medical centers to assess what CIH approaches were available. 4. CIHEC Veterans CIH Survey—We conducted a survey among a national sample of veterans in July 2017 to learn their use of, satisfaction with, and interest in 24 CIH approaches. 5. CIHEC PRIMIER—We replicated BraveNet’s longitudinal study of patient-reported outcomes (PROs) in 2 VA sites to examine how CIH approaches are associated with changes in PROs over time. 6. CIHEC Battlefield Acupuncture (BFA)—We examined BFA implementation challenges and strategies. Rationale: The VA has been at the forefront of providing CIH approaches to patients. Other health-care systems and individual providers can learn from our experiences in implementing and evaluating CIH approaches. Objectives: The aim is to learn what CIH policies the VA has developed and activities they are conducting; list the top 3 CIH approaches that veterans are requesting; list the top CIH approaches being provided and the implementation barriers and strategies used to overcome those barriers; summarize the Whole Health System model that the VA is adopting; learn about the policies and resources the VA’s IHCC is providing to individual providers, staff and facilities, as they attempt to implement CIH; learn about the effectiveness of CIH for a variety of patient health outcomes; and learn about CIH implementation issues. Outline: 1. We will present what the VA’s IHCC is doing to facilitate the implementation of CIH across the VA system. 2. We will discuss how we are evaluating the implementation and effectiveness of the CIH portion of the Whole Health program at 18 VA medical centers, using semistructured interviews, implementation checklists, and surveys of patient-reported outcomes. 3. We will present the findings of the CIHEC Environmental Scan online survey of CIH Provision at all VA medical centers. 4. We will present the findings of the CIHEC Veterans CIH Survey. 5. Tai chi, yoga, acupuncture, and guided imagery all resulted in significant improvements in Veterans’ PROs, especially pain, perceived stress, and functioning. 6. We will review the implementation barrier and strategies used to overcome those barriers. (3859) Cost-effectiveness of Mindfulness-based Stress Reduction Versus Cognitive Behavioral Therapy Versus Usual Care for Chronic Low Back Pain Melissa L Anderson, MS1, Benjamin H Balderson, PhD1, Karen Sherman, PhD, MPH1, Judith A Turner, PhD2, Daniel C Cherkin, PhD1 and Patricia M. Herman, ND, PhD3 1Kaiser Permanente Washington Health Research Institute, Seattle, Washington 2University of Washington, Seattle, Washington 3RAND Corporation, Santa Monica, California Abstract Purpose: Chronic low-back pain (CLBP) is expensive in terms of health-care costs and lost productivity. Mind–body interventions have been found effective for back pain, but their cost-effectiveness is unexplored. The purpose of this study was to determine the cost-effectiveness of 2 mind–body interventions, cognitive behavioral therapy (CBT), and mindfulness-based stress reduction (MBSR) for CLBP. Results: This economic evaluation was limited to the 301 health plan members enrolled for at least 180 days in the years pre- and postrandomization. The mean incremental cost per participant to society of CBT over usual care (UC) was $125 (95% confidence interval [CI]: −4103, 4307) and of MBSR was −$724 (CI: −4386, 2778)—that is, a net saving of $724 compared to UC. Incremental costs per participant to the health plan were $495 for CBT over UC and −$982 for MBSR, and incremental back-related costs per participant were $984 for CBT over UC and −$127 for MBSR. These costs (and cost savings) were associated with significant gains in quality-adjusted life years over UC: 0.041 (0.015, 0.067) for CBT and 0.034 (0.008, 0.060) for MBSR. Conclusions: In this setting, CBT and MBSR have high probabilities of being cost-effective, and MBSR may be cost saving, as compared to UC for adults with CLBP. These findings suggest that MBSR, and to a lesser extent CBT, may provide cost-effective treatment for CLBP for payers and society. (3873) Back to the Future: Probiotics and Microbial-host Keystone Organisms and Their Essential Functions Craig D Hopp, PhD1 and Linda C Duffy, PhD, MPH1 1National Institutes of Health, Bethesda, Maryland Abstract Overview: Probiotics are “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host.” Probiotics are derived from human gut microorganisms that have coevolved with us. Probiotic formulations include vaccines, drugs, functional foods, dietary supplements, and topical applications. Over 80% of our immune system is found in the intestines and microbial communities play an intimate role in immune regulation imbalances throughout life. Our mental health could also be a sign of intestinal imbalance. Much attention in human microbiome research has recently shifted to the ecological concept of keystone microbes that, by definition, are of low abundance, the removal of which has destabilizing impacts on energy metabolism and host health. The search has intensified for identifying keystone microbial groups and their genes that may provide novel molecular footprints (immunogenic; metabolic; neurologic; physiologic) and a rationale basis for designer probiotics for the future. This symposium will convene researchers from federal government and broader research community. The symposium will open with an invited talk from Justin Sonnenburg, PhD, Stanford University, who will give a probiogenomics view in the search for keystone (probiotic) groups and functions in the Ancestral Microbiome, of Hunter-Gatherers. Grace Douglas, PhD, lead scientist in Genomics and Probiotic Functional Foods at National Aeronautics and Space Administration (NASA) will talk on What NASA is learning about probiotics, microbiomes, and space flight. Melanie Gareau, PhD at University of California, Davis, will share links between probiogenomics, early life programming in the microbiota-gut-brain axis. Sean Brady, PhD at Rockefeller University, will give an exciting glimpse of probiotic biosensors in live cell signaling pathways. Linda Duffy, PhD program director for the National Center for Complementary and Integrative Health (NCCIH) Probiotics and Microbiome portfolios will Chair the Session concluding with directions being addressed by the Trans-National Institutes of Health (NIH) Probiotics Microbiome Workgroups and Omics Consortium and NIH/NCCIH research initiatives. Craig Hopp, PhD, DER deputy director, will moderate the symposium and panel discussion. Rationale: Rationale: Why the topic is important and its relevance to the conference themes? The probiotic concept that the gut flora can be modified and harmful microbes replaced with beneficial ones was introduced in 1907. Probiotics are naturally derived, orally ingested foods and drug products commonly used by the consumer public that have yielded many marketed products with somewhat equivocal evidence of health benefits. We gain our natural exposure to these beneficial microorganisms that comprise the Human Microbiome in 2 essential ways: (1) through our mothers and childbirth and (2) from our environment and we are dependent on the microbes that inhabit our guts for essential physiologic, immunologic, and metabolic functions. With innovation technologies and emerging 3-D computational platforms available, exciting new evidence is accumulating from ancestral microbiomes identifying beneficial properties of keystone species and groups that may be evolving in low abundance but when they or selected genes are missing can lead to health consequences, chronic disease, and inflammatory conditions typically observed in Western lifestyles. The ongoing efforts of the Trans-NIH Probiotic/Prebiotic Omics Consortium coupled with the long-standing NIH Human Microbiome Project to rigorously substantiate a probiotic rationale for use and guide new research directions have significantly contributed to rapid advances in our understanding and development of molecular footprints that deserve much more investigation. The convergence of new strategies including the targeting of keystone species and groups in probiogenomics and microbiome collections are at a critical juncture requiring that rigorously validated mechanistic discoveries are further translatable to more accelerated clinical research. Essential for this transition is a diversity of thinking (systems biology, metabolism, microbiology, physiology, and immunology) and standards for multiomic and innovation technologies and models. The Symposium session seeks to broaden the base of what defines the current search for keystone group membership in probiotics and microbiome studies by inviting investigators to share their vision, approach, and results to enhance understanding of signaling pathways and underlying mechanisms of probiotic action. Objectives: Objectives: What participants will know or be able to do as a result of this session? The symposium aims to (1) introduce the intriguing search for keystone ancestral groups of probiotics, and their genes, challenges in the search, and how findings will benefit designer probiotics and their genes in the future; (2) stimulate interest among junior and senior investigators relevant to advancing next-generation probiotics and microbiome studies; and (3) foster new collaborative, multidisciplinary probiotic, genomic, and microbiome research that advances basic, translational, and clinical research programs. Outline: Topic outline: Main points of the session Submission topic(s): • Research  ○ State of the science/evidence base for integrative modalities  ○ Natural products/botanicals/supplements (3874) Nurturing the Next Generation of Healers Julian Jimenez, BA1, Victor Sierpina, MD1 and Julie McKee, MD1 1Galveston, Texas Abstract Overview: The Physician Healer Track (PHT) is a 4-year longitudinal curriculum designed to help students maintain the altruistic spirit that brought them to medical school. The 4 pillars of PHT are wellness, mindfulness, communication, and being with suffering. Enthusiasm for this work has resulted in about 25% of incoming students enrolling in PHT. It is our hope that PHT helps students weather medical training with an increased sense of efficacy and resilience. Preliminary data suggest that we are succeeding. Rationale: Students come to medical school in order to help people. They matriculate as bright, energetic, and altruistic individuals. The standard medical school curriculum focuses heavily on basic and clinical sciences which teach how to fix patients. This curriculum has long been associated with decreased well-being, diminished empathy, and increased burnout. The PHT helps students gain skills in personal reflection, communication, wellness, mindfulness, and being a healing presence for those who are suffering. It is our hope that PHT helps students weather medical training with an increased sense of efficacy and resilience. Preliminary data suggest that we are succeeding. Objectives: Participants will be able to describe a 4-year longitudinal curriculum focused on creating our next generation of healers, describe the impact of this curriculum from a student’s perspective, describe the results of data collected over the past 5 years, and experience an activity designed to shift personal perception. Outline: 1. Overview of curriculum  A. Topics and format of monthly evening small group meetings  B. Topics and experiential activities for the 2-month summer preceptorship  C. Topics and experiential activities for the senior elective  D. Required and optional readings 2. Student perspective  A. Why did you sign up for this in the first place?  B. What have you learned that has been helpful?  C. What has been most difficult for you on this journey?  D. How do you see this affecting you in the future both personally and professionally? 3. Data  A. Results of data collected from students about the curricular content  B. Results of data collected about impact on personal life  C. Results of data collected about professional development 4. Experiential activity  A. Perception and your “to do list” (3881) Patients Receiving Integrative Medicine Intervention Efficacy Registry: A BraveNet Practice-based Research Evaluation Focusing on a Chronic Pain Cohort Ben E Kligler, MD, MPH1, Jeffery A Dusek, PhD1, Donald I Abrams, MD1, M Diane McKee, MD1 and Rowena Dolor, MD1 1Durham, North Carolina Abstract Purpose: BraveNet is the first national integrative medicine (IM) practice-based research network. Patients Receiving Integrative Medicine Intervention Efficacy Registry (PRIMIER) is a prospective, nonrandomized, observational evaluation conducted at 17 BraveNet sites. A main purpose of PRIMIER is to collect patient-reported outcomes at specified time periods across the entire BraveNet. A secondary purpose examines whether specific clinical populations (eg, chronic pain) or IM interventions are associated with improved outcomes over time. Results: Repeated-measures analyses were performed on interim data to assess change from baseline through 12 months. Through April 2017, 3809 patients enrolled in PRIMER and 1392 met the criteria for chronic pain. Pain participants were white (87%), female (77%) with a mean age of 49.6 (standard deviation [SD] 14.6). On the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety, Fatigue and Pain Interference scales, our population-reported elevated levels (0.5 SD) relative to national norms. Significant reductions were observed at the 12-month assessment on the all 7 PROMIS-29 subscales and across all 4 timeperiods (2, 4, 6, and 12 months) on Fatigue, Pain Interference, and Pain Intensity constructs. Perceived Stress Scale 4 scores significantly improved across 3 of the 4 assessments (2, 4, and 12 month), whereas the Patient Activation Measure scores (which were already high at baseline) significantly increased at the 12-month assessment only. Conclusions: To date, PRIMIER results indicate a profound improvement across all of the tested PROMs. Further analyses will provide insights as to whether specific IM interventions or combinations are associated with larger improved outcomes in the chronic pain cohort and other populations. (3886) Changing the Pain Care Paradigm: Essential Actions for Moving Beyond Medications Leonard Wisneski, MD1, Robert Twillman, PhD, AIPM2, David O’Bryon, JD3, Alison M Whitehead, MPH4 and Margaret A Chesney, PhD4 1Denver, Colorado 2Lawrence, Kansas 3Academic Collaborative for Integrative Health, Bethesda, Maryland 4San Francisco, California Abstract Overview: New guidelines, regulations, and legislation are nearly universal in recommending that first-line treatment for pain should focus on nonpharmacological treatments. Very few recognize the existing challenges inherent in following those recommendations. Many of these recommendations lack details about which treatments should be pursued for which patients. Other access challenges include, but are not limited to: inadequately educated providers, regarding how to optimally assess and refer people with pain; lack of central resources where professionals with nonpharmacological expertise can be identified as referral providers; a paucity of providers available in some, particularly rural, areas; and inadequate insurance coverage leaving people with pain paying out of pocket for care, something many find challenging. This panel discussion, chaired by Margaret Chesney, past chair of the Consortium, will introduce these barriers and challenges to implementing the recommendations for nonpharmacological pain treatments and the pressing need to address them. Bob Twillman, executive director of the Academy of Integrative Pain Management, will discuss efforts aimed at helping providers assess patients with pain with an eye toward developing patient-centered care plans that include appropriate nonpharmacological treatments. David O’Bryon, chair of the Academic Collaborative for Integrative Health, will follow with examples of professions, including acupuncture and chiropractic, which engage in educational and outreach efforts to clinical providers to convey the benefits of nonpharmacological treatments, a first step in developing referral resources. Alison Whitehead, the Consortium’s Policy Working Group’s Chairperson, will discuss the VA’s Patient-Centered Care and Cultural Transformation Program and highlight lessons learned regarding incorporation of nonpharmacological treatments into that program. Finally, Len Wisneski, chair of the Integrative Health Policy Consortium, will review the outcomes of the recent Pain Care Policy Forum, a meeting that involved professional organizations, pain patient advocacy organizations, and third-party payers, with a focus on improving insurance coverage for nonpharmacological treatments. Rationale: While the new guidelines calling for nonpharmacological approaches to pain are a major advance for integrative medicine and health, there are many challenges that need to be met in order for these strategies to be adopted widely into health care. It is important that these challenges be met before the current attention to this issue fades and new pharmacological approaches for pain management are introduced. The Consortium and other integrative health organizations are taking steps to communicate what is known about the evidence base for integrative approaches. This panel discussion will focus on the critical next steps needed to translate that evidence in to action with a focus on education, access, and coverage. Educational efforts need to be directed to both health-care providers and the public about nonpharmacological treatment options, including the evidence base as well such details as expectations regarding frequency, dosing, and shared responsibility. Access in the context of this panel discussion will involve not only patients’ access to nonpharmacological care, but clinicians’ access to a resource or system to facilitate referring patients to experienced practitioners who can provide nonpharmacological pain care. Coverage for nonpharmacological care is lacking despite the recommendations coming from the National Academy of Medicine, Food and Drug Administration, Joint Commission, and many other organizations. This panel discussion will present steps that are being taken to advance efforts to improve insurance coverage in today’s volatile heath care environment. Objectives: As a result of this panel discussion, attendees will understand the challenges that must be overcome in order for nonpharmacological treatment to be widely utilized as the first-line treatment for pain, recognize the importance of assessing patients with the goal of developing patient-centered care plans that include appropriate nonpharmacological treatments for pain, and appreciate the need to create systems to facilitate referrals by clinical providers to professionals experienced in nonpharmacologic treatments for pain. Outline: 1. There are barriers and challenges to implementing the recommendations for nonpharmacological pain treatments and a pressing need to address them. 2. Specific challenges to implementation include inadequate education for providers and the public about nonpharmacological approaches, a lack of resources where experienced professionals with nonpharmacological expertise can be identified for referrals, availability of providers on some rural areas, and inadequate insurance coverage. 3. Efforts are underway to help providers assess pain patients and develop patient-centered care plans that include nonpharmacological treatments. 4. There are examples from several professions, including acupuncture and chiropractic, which are reaching out to clinicians, conveying the benefit of nonpharmacological treatments—a first step toward developing referral resources. 5. The VA’s Patient-Centered Care and Cultural Transformation Program provides lessons learned regarding incorporation of nonpharmacological treatments into pain management. 6. Professional organizations, advocacy organizations, and third-party payers are making efforts to improve insurance coverage for nonpharmacological treatments for pain. (3889) Nutritional Pain Management: Design, Implementation, and Evaluation of a Certification Course for Diverse Pain Providers Meg Sweeney, BS1, 2, Nancy A Cotter, MD, FACN3 and Robert A Bonakdar, MD, FAAFP, FACN4 1Western University of Health Sciences 2The College of Osteopathic Medicine, Pomona, California 3Veterans Health Administration, Montclair, New Jersey 4La Jolla, California Abstract Overview/Background and Hypothesis: Several recently guidelines have endorsed the use of nonpharmacologic interventions for first-line management of pain. As pain can coexist with and result from metabolic dysregulation including obesity, metabolic syndrome, and nutrient deficiency, nutritional interventions hold promise for impacting pain in selected populations. Unfortunately, clinicians often have suboptimal education and comfort in introducing and implementing nutritional interventions in the setting of pain. We hypothesize that a certification course will have a positive impact on clinician confidence and implementation of nutritional strategies in the setting of pain. Intervention: A 6-h continuing educational course was created to address key learning areas related to pain. These areas included the role of diet in promoting pain (ie, inflammatory, nutrient deplete, and obesogenic diets); the role of diet in reducing pain (ie, reduction of inflammation, weight management, and nutrient deficiency); as well as how to introduce a health promoting diet and evidence-based nutrients in population associate by systemic inflammation and deficiency (ie, rheumatoid arthritis, migraine, and metabolic neuropathy). Plan: The initial course will be provided to 100 clinicians of diverse backgrounds as part of a larger pain-related continuing education conference in the fall of 2017. In addition to a postintervention knowledge assessment, attendees will have a pre- to postevaluation of their level of education, knowledge base, and comfort level in discussing and implementing nutritional intervention for those in pain. They will also be asked about scenarios they find particularly challenging (ie, pain associated with obesity) with discussion incorporated into the course. Postintervention, attendees will have long-term monitoring to evaluate the impact of the certification on practice changes related to the course. Postcourse data will be analyzed to gauge the impact of the course as well as plan future interventions in the content area. Rationale: Chronic pain and obesity are both significant public health concerns which appear to be increasing. Nutritional factors including deficiency and proinflammatory diets appear to be important contributing factors to both epidemics with nutritional counseling and support appearing as potentially helpful interventions in helping to mitigate this scenario. Unfortunately, recent studies demonstrate that less than one third of the time do patients receive adequate nutritional counseling. A continuing education program geared toward diverse pain management clinicians was created with the goal of improving the knowledge base, confidence, and degree of counseling regarding nutrition in the setting of pain. Objectives: Diet is associated with pain in both curative and causative relationships. The great majority of pain syndromes are associated with chronic inflammation. Anti-inflammatory foods and dietary patterns have been used successfully to treat chronic pain syndromes. Food sensitivities and nutrient deficiencies are associated with common pain syndromes. Clinicians should have a high degree of awareness of the role of diet in the amelioration and exacerbation of pain. Stepwise counseling by clinicians of all backgrounds can help to incorporate diet as an important and accessible treatment for pain syndromes. (3901) Utilization of Integrative Medicine in an Interdisciplinary Intensive Outpatient Program for Service Members With Combat-related Traumatic Brain Injury and Psychological Health Conditions Melissa Walker, MA1, Manoj Bhasin, PhD2 and Thomas J DeGraba, MD1 1Walter Reed National Military Medical Center, Bethesda, Maryland 2Beth Israel Deaconess Medical Center, Boston, Massachusetts Abstract Overview: Combat operations and training injuries have resulted in traumatic brain injury (TBI) in over 370 000 service members (SM) since 2001. The occurrence of behavioral health comorbidities in up to 40% of these SM presents the need for novel treatment paradigms to address persistent symptoms. The National Intrepid Center of Excellence (NICoE) developed a 4-week interdisciplinary, holistic patient-centric, and family-centric intensive outpatient program (IOP) utilizing conventional and integrative medicine treatments to place SM on a trajectory of recovery. In an attempt to characterize the injury and response to the implementation of the arts and other mind–body techniques in the care of these service members, a multimodal assessment approach including genomics is used. This symposium will address the interdisciplinary integrative care model in the Military Health System and will include the description of the IOP used at NICoE as well as mind–body techniques used in the TBI Pathway of Care Network (10 min); the use of creative arts therapies (art, music, dance/movement, and drama) as integrated components of behavioral health assessment of SM and as treatment strategies for ongoing recovery (30 min); the effects of the integrative care model on physiological parameters including brain wave patterns measured by magnetoencephalography (MEG) and autonomic patterns measured by transcranial Doppler (TCD) derive cerebral vasomotor reactivity metrics (20 min); studying effect NICoE intervention on genomics landscape of SM to identify key molecular pathways associated with healing and further their association with the neurological and behavioral response to treatment (20 min). Rationale: Combat operations and training injuries have resulted in traumatic brain injury in over 370 000 SMs since 2001. The occurrence of behavioral health comorbidities in up to 40% of these SM presents the need for novel treatment paradigms to address persistent symptoms. The NICoE developed a 4-week interdisciplinary, holistic patient-centric, and family-centric IOP utilizing conventional and integrative medicine treatments to place SM on a trajectory of recovery. Objectives: In an attempt to characterize the injury and response to the implementation of the arts and other mind–body techniques in the care of these service members, a multimodal assessment approach including genomics is used. This symposium will address the interdisciplinary integrative care model in the Military Health System and will include the description of the IOP used at NICoE as well as mind–body techniques used in the TBI Pathway of Care Network (10 min); the use of creative arts therapies (art, music, dance/movement, and drama) as integrated components of behavioral health assessment of SM and as treatment strategies for ongoing recovery (30 min); the effects of the integrative care model on physiological parameters including brain wave patterns measured by MEG and autonomic patterns measured by TCD derive cerebral vasomotor reactivity metrics (20 min); and studying effect NICoE intervention on genomics landscape of SM to identify key molecular pathways associated with healing and further their association with the neurological and behavioral response to treatment (20 min). Outline: 1) The interdisciplinary integrative care model in the Military Health System and will include the description of the IOP used at NICoE as well as mind–body techniques used in the TBI Pathway of Care Network. 2) The use of creative arts therapies (art, music, dance/movement, and drama) as integrated components of behavioral health assessment of SM. 3) The effects of the integrative care model on physiological parameters including brain wave patterns measured by MEG and autonomic patterns measured by TCD derive cerebral vasomotor reactivity metrics. 4) Studying effect NICoE intervention on genomics landscape of SM to identify key molecular pathways associated with healing. (3903) Expansion and Spread of Student-lead Integrative Medicine Curricula Change Marni Hillinger, MD1, Christian Adams, MS-32, Agata Harabasz, MS-23, Lauray MacElhern, CNS3 and Henri Roca, MD3 1Vanderbilt University, Nashville, Tennessee 2Joan C. Edwards School of Medicine at Marshall University, Huntington, West Virginia 3Little Rock, Arkansas Abstract Overview: The Leadership and Education Program for Students in Integrative Medicine (LEAPs) has continuously operated for 10 years. During that time, over 300 students have completed the Program. LEAPs brings a transprofessional group of health professional students to a residential week in an optimal learning environment to learn about common integrative medicine modalities, to experience those modalities, and to develop leadership skills directed toward incorporating integrative medicine curricula in their home institutions. Each student implements a home project that increases the visibility of integrative medicine, increases access to integrative medicine teaching or experientials, or increases the access to underserved stakeholders using student providers. These programs have been very successful. This workshop will review the structure and intent of the LEAPS program, share the experience of the student leaders of recent LEAPs, demonstrate the breadth and depth of home-based programs, and allow participants to experience some of the leadership development techniques. Rationale: Integrative medicine curricula programming is often lacking in institutions that exist in underserved communities, are located in more rural or isolated portions of the country, or exist a freestanding training institutions. In order to grow sustainable curricula change, student leaders are required. LEAPs grows student leaders and supports their development over the course of their training. This is submitted for a workshop. Objectives: Participants will be able to list the components of an optimal learning environment; sculpta miniversion of LEAPs for their home institutions; experience a portion of the leadership development program; and describe the impact at home institutions of student-lead integrative medicine programming. Outline: 1. History of LEAPS 2. Components of an optimal learning environment 3. Structure of LEAPs 4. Experience of leadership training technique 5. Discussion of home institution student-lead projects 6. Creation of mini LEAPs for participants’ home institution (3908) Dietary Sugar Induces Breast Tumorigenesis in Murine Models Partially Through 12-Lipoxygenase and Immune Modulation Lorenzo Cohen, PhD1, Peiying Yang, PhD1, Yan Jiang, PhD1, Patrea Rhea, BS1 and Mihai Gagea, DVM, PhD1 1Houston, Texas Abstract Purpose: High added sugar consumption might be associated with increased breast cancer (BCa) risk, but the data are not consistent and the molecular mechanisms remain unclear. We examined the effect of sucrose-enriched diet in the development of primary and metastatic BCa and relevant mechanisms. Results: A diet with 125 g/kg sucrose (equivalent to the average U.S. sugar consumption) shortened breast tumorigenesis in MMTV-ErbB2/neu mice and promoted the development of BCa in mice bearing 4T1 cells and MDA-MB-231 cells. Further, sucrose diet significantly increased the numbers of lung nodules 2-fold in 4T1 animal models (P < .05). There was upregulation of expression of 12-LOX protein and its metabolite, 12-HETE, within the tumor tissues across the 3 BCa models. When mice were fed with sucrose-enriched diets, the average mammary tumor weight in ALOX12 deficient MDA-MB-231 cell-derived tumors were smaller than that of tumors derived from scramble MDA-MB-231 cells. Furthermore, sucrose-enriched diet led to 2-fold increases in protein and mRNA of monocyte chemoattractant protein 1 (MCP-1) in serum and tumor tissues of MMTV-ErbB2/neu mice and mice bearing 4T1 mammary tumors. Intriguingly, 12-HETE treatment concentration dependently increased MCP-1 in MDA-MB-231 cells, whereas a selective 12-LOX inhibitor, ML355, inhibited the MCP-1 gene expression in MDA-MB-231 cells. Finally, 4T1 mammary tumors from sucrose diet had 2-fold higher inflammation score and infiltration of CD68+ cells (tumor-associated macrophage) compared to that of starch control diet. Conclusions: Our data provide evidence that added sugar accelerates the development of BCa through upregulating expression of 12-LOX and immune modulation, especially MCP-1 pathway. (3915) Building Integrative Medicine and Wellness Into Curriculum Anne E Weisman, PhD, MPH, LMT1 1University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada Abstract Overview: University of Nevada Las Vegas (UNLV) School of Medicine’s innovative curriculum is relationship-based, designed to foster strong ties between faculty and students, between students and patients, and between the students and the community. Early in the design and creation of this curriculum, the importance of the inclusion of integrative medicine was recognized. As the integrative medicine curriculum was taking shape, the topics were intentionally placed throughout the longitudinal curriculum throughout each learning block to support the material being covered in each. UNLV School of Medicine created the integrative medicine thread for patient care and extensive wellness programming for practitioners to work in tandem and support each other. This design will help medical students, faculty, and residents with the balance of caring for others as well as caring for themselves. UNLV School of Medicine provides medical students with didactic and experiential learning for specific skills to decrease stress and enhance wellness while in school and throughout their careers. The intent is to create the awareness and practice of integrative medicine during the undergraduate medical education. The curriculum promotes students’ well-being and exposes students to additional perspectives and modalities that they can apply with their patients in conjunction with conventional medicine. It is a comprehensive curriculum that includes the topics of preventive health care, physical activity, stress management, flexibility, addressing addictive behaviors, successful sleep, the importance of social supports, meditation, gratitude, nutrition, art, theater, and nature. UNLV medical students have the opportunity to experience and participate in a variety of regularly scheduled modalities including tai chi, meditation, yoga, mindfulness, narrative medicine, and graphic medicine. As the medical students take up the rigors of the study of medicine, the integrative medicine and wellness curriculum will provide practical strategies to enhance their own self-care as well as training the future physicians to care for the whole person. Rationale: This topic is important and relevant to the conference theme Collaboration in Action: Advancing Integrative Health through Research, Education, Clinical Practice and Policy because UNLV School of Medicine created their curriculum with integrative health topics throughout all 4 years of training. This opportunity presented through the creation of a brand new medical school in a medically underserved area that saw the future of medicine heading this direction. Integrative medicine and health connects patients to themselves, their practitioners, and to their communities. It reminds us of our innate ability to heal while honoring all of the available and appropriate treatments. It is also an issue of understanding and communication. Current research suggests that many patients are using some forms of integrative medicine and very few communicate this to their doctors. This gap in communication creates more gaps in care. Many physicians who trained before were not taught about this and express their discomfort discussion this with patients because of their lack of knowledge. Through creating a new school of medicine that honors all forms of healing, the lines of communication and dialogue are open to train medical students, residents, faculty, and physicians. Objectives: Participants will be able to look at their own curriculum and identify places that this curriculum fits and assess the impact of the curricular changes. (4073) Effects of Aloe on the Regulation of Thyroxine Release in FRTL-5 Thyroid Cells Byoung-Seob Ko, PhD1, Hiroe Go, PhD1 and Jin A Ryuk, PhD1 1Korea Institute of Oriental Medicine, Daejeon, Republic of Korea Abstract Purpose: We investigated the effects of aloe on thyroxine production in FRTL-5 cells. Results: In the 6H group (with thyroid-stimulating hormone [TSH]), thyroxine release was decreased compared with the control group. Moreover, mRNA and protein expression of thyroid peroxidase (TPO) which is one of the important factors of thyroxine synthesis were decreased significantly. Conversely, in the 5H group (without TSH), thyroxine release and protein expression of TPO were increased compared with the control group. To know the mechanism of regulatory effects of aloe on thyroxine release, we investigated protein expression of upstream key factors of thyroid hormone synthesis such as phospho-ERK, phospho-CREB, phospho-AKT, and PKA. Although protein expression of phospho-ERK, phospho-CREB, and PKA was decreased in 6H group, those of 5H group was increased. Protein expression of phosphor-AKT was not changed in both 6H and 5H groups. Conclusions: These results suggest that aloe could be candidate for TSH-like substances and play a regulatory role in thyroxin release via PKA-CREB or PKA-ERK pathway. Poster-experiential, Symposium, Panel Discussion Abstracts (61) Kampo Medicine (Traditional Japanese Medicine) for Gastrointestinal Disease Under Integrated Universal Health-care Coverage in Japan Keiko Ogawa, PhD1, Junsuke Arimitsu, PhD2 and Kengo Nakata, MPH3 1Kanazawa University, Kanazawa, Japan 2Kanazawa University Hospital, Kanazawa, Japan 3Japanese Society of Traditional Acupuncture and Moxibustion, Tokyo, Japan Abstract Overview: The effectiveness of traditional Japanese (Kampo) medicine in gastrointestinal disease is attracting more and more attention in the Japanese medical system. Kampo, comprising both Kampo herbal medicine and manual therapies such as acupuncture, moxibustion, and acupressure, is the most frequently used alternative and complementary medicine in Japan. The aim of Kampo therapy is to improve patients’ condition whatever their diseases are. The illness concept of Kampo, body and mind as one, has similarity with gut-brain axis (GBA) which consists of bidirectional communication between the central and the enteric nervous system, linking emotional and cognitive centers of the brain with peripheral intestinal functions. It can also be used easily for patients because it is operated under integrated universal health care by the Japanese government. Patients are diagnosed from both viewpoints of modern and Kampo medicine, and they are treated with the appropriate combination of both therapies. This characteristic suggests an ideal form of integrated medicine, where scientific and analytical approaches of Western medicine are integrated with holistic approach of Kampo Medicine. Though its origin was in ancient China, Kampo medicine has been developed under the influence of Japanese nature and culture, and nowadays is working as an independent medical system significantly different from Traditional Chinese Medicine (TCM). We would like to discuss on the advantage and disadvantage of Kampo medicine for patients through some clinical researches and reports. According to the 4 key objectives of World Health Organization (WHO) strategy: policy to integrate traditional medicine (TM) within national health-care systems; establishment of the safety, efficacy, and quality of TM; preservation of the right of patients to access TM; and rational use to promote therapeutically sound use of appropriate TM by practitioners and consumers, Japanese medical system might be a good example for countries where TMs are used. Rationale: The illness concept of Kampo, body and mind as one, has similarity with GBA which consists of bidirectional communication between the central and the enteric nervous system, linking emotional and cognitive centers of the brain with peripheral intestinal functions. Therefore, Kampo medicine is effective and has played more and more important roles in closing the gap between modern medicine and demand of patients. According to the 4 key objectives of WHO strategy: policy to integrate TM within national health-care systems; establishment of the safety, efficacy and quality of TM; preservation of the right of patients to access TM; and rational use to promote therapeutically sound use of appropriate TM by practitioners and consumers, Japanese medical system might be a good example for countries where TMs are used. We would like to discuss on the advantage and disadvantage of Kampo medicine for patients with gastrointestinal disease through some clinical researches and reports. It will establish understandable concept in Kampo medicine and patients can access to Kampo medicine more easily. Objectives: They would like to learn the advantage and disadvantage of Kampo medicine for patients through some clinical researches and reports. They can adopt this knowledge to their clinical or research activity, and we might cooperate to make better role of TMs. Outline: We would like to discuss on the advantage and disadvantage of Kampo medicine for patients with gastrointestinal disease through some clinical researches and reports. It will establish understandable concept in Kampo medicine and patients can access to Kampo medicine more easily. (1102) Dietary Ingredients as an Alternative Approach for Mitigating Musculoskeletal Pain: Evidence-based Recommendations for Practice in the Military Cindy C Crawford, BA1, Courtney Boyd, MA1, Patricia Deuster, PhD2 and Scott Cota, CAPT3 1Thought Leadership and Innovation Foundation, McLean, Virginia 2Uniformed Services University, Bethesda, Maryland 3US Special Operations Command MacDill AFB, Tampa, Florida Abstract Overview: Alternative approaches to managing chronic pain resulting from musculoskeletal injuries (MSK-I) are needed. MSK-I are one of the most burdensome conditions in the U.S. Military, as they are a leading cause of pain, medical encounters, lost duty time, and disability across the U.S. Military. Already about 55%–76% of Service members use dietary supplements for various reasons, and using such products for a wide-range of pain conditions has become increasingly popular. Decisions to use dietary supplements are often driven by information that is not evidence based, such as from peers, family members, and other sources. If such products are going to be used for mitigating MSK pain, evidence-based research is required to inform appropriate and safe decisions about ingredients. In this symposium, we will introduce the methodological approach we used to provide a clear, comprehensive, and unbiased synopsis of the state of the science regarding dietary ingredient evidence for MSK-I pain in order to provide evidence-based recommendations to Special Operations Force (SOF) personnel. We then will demonstrate how this process allowed key stakeholders and subject matter experts to develop transparent, evidence-based information to direct policy decisions regarding the appropriate selection and use of dietary ingredients for improving pain and pain-related outcomes. Finally, we will describe the results and recommendations, which may be used to inform policy decisions on this important topic. Rationale: As noted, MSK pain is ubiquitous throughout the military due to the extreme physical demands of training and combat. Across the military, options for MSK pain are limited primarily to medications (eg, nonsteroidal anti-inflammatories/NSAIDs), injections, dry needling, physical therapy, acupuncture, and other modalities. One alternative that has not been considered as carefully is natural ingredients found in food and used in dietary supplements. In addition to the military, MSK pain is also common in the civilian sector and may, in fact, be a surrogate for health quality. We will present the state of the science recommendations about using specific dietary ingredients as an alternative or adjunctive approach to minimizing chronic musculoskeletal pain. Our recommendations take into account risk-to-benefit, impact on various pain-related outcomes, patient preferences/values, and cost/resources. The methodological process used can be applied to any integrative approach in need of trusted evidence-based recommendations. Objectives: Upon completion of this Symposium, participants will (1) describe a transparent, streamlined approach for developing evidence-based recommendations for providers to consider using various dietary ingredients as an alternative approach for mitigating chronic musculoskeletal pain; (2) demonstrate how evidence can be integrated with clinical acumen in a transparent, structured fashion to develop trusted evidence-based recommendations regarding the appropriate use of dietary ingredients for pain; and (3) translate the evidence-based recommendations for future research initiatives and for use in various health-care venues. Outline: • The presenters will detail the purpose of the project and the intended impacts specifically for SOF. • The presenters will describe the methodological approach taken to determine whether current research on dietary ingredients for chronic musculoskeletal pain could provide sufficient evidence to inform decisions for both practice and self-care. • The presenters will summarize the state-of-the-science across dietary ingredients for chronic musculoskeletal pain. • The attendees will learn how to achieve evidence-based recommendations, using decision factors applied within the Grading of Recommendations, Assessment, Development and Evaluation Framework, and a multivoting, modified-Delphi process. • The presenters will discuss how evidence-based information can be used to direct policy decisions regarding the appropriate selection and use of dietary ingredients for improving pain and pain-related outcomes. (1166) Psycho-neuro-endocrine-immunology Emotions and Reflection on Disease Gianpaolo Giacomini1 1Pianoro, Italy Abstract Overview: Emotions are the cornerstone of human experience, both in health and in the illness. They change the way in which we observe life and arise from the deepest interpretation patterns that lie in our minds. Social, parental, scholastic, cultural, and religious education are all factors that intervene when we have to judge our health. Often, an incorrect belief can lead us to evaluate a fact in a distorted way, thus showing us a disease where there is actually an opportunity. Healing is change, overcoming, inner conscious transformation, especially with regard to mental patterns that force us to judge reality. The chain that links mental beliefs, emotions, and activation of the psycho-neuro-endocrine-immunology (PNEI) axes of the body can affect our health or our illness. If we want to heal and help our patients, we must first and foremost know and deal with ourselves, our mind, and our mental patterns that inevitably and unconsciously make us often experience the same problems. Rationale: Every well-being and medical practitioner faces not only the disease but also the sick person. It is therefore indispensable to understand how much the emotional side of a healthy or sick person is affecting his physical and mental health. Medicine and care must be more and more about the person and not the disease. Objectives: The aim is to understand the complex reality of interaction between education, mental patterns, beliefs, emotions, and axes of the PNEI body; understand the crucial difference between acting and reacting to the choices of life; know how to treat breathing techniques, postural, integrative (eg, flower therapy) the emotional side of the patient; and understand the environment in which the person lives, particularly familiar, as a mental conditioning. Outline: -The mental reality of the human being: the mind as an instrument of the soul to manifest to the body. - PNEI communication paths between mind and body, endocrine and neurochemical axes, and neuronal plasticity. -The life-giving emotions and the way of transmutation, not the suppression. -Illness as a manifestation in the body of the emotional and mental state of the human being. -Effect of controlled respiration on sympathetic and parasympathetic system. -Use of postural rehabilitation and body consciousness. -Revealing your own self and recognizing interactive family dynamics. (2168) Integrative Health Education: Results of a National Interprofessional, Primary Care Educational Program Maryanna D Klatt, PhD1, Audrey J Brooks, PhD2, Benjamin Kligler, MD, MPH2, Victoria Maizes, MD2, Mary Koithan, PhD, CNS-BC, FAAN2 and Patricia Lebensohn, MD2 1College of Medicine, The Ohio State University, Columbus, Ohio 2Tucson, Arizona Abstract Overview: The University of Arizona Center for Integrative Medicine in collaboration with the Academic Consortium for Integrative Medicine and Health established the Health Resources and Services Administration-funded National Center for Integrative Primary Healthcare (NCIPH) in 2014. The NCIPH goal is to transform primary care health professional education to include an emphasis on providing an Integrative Health (IH) approach to patient care utilizing an interprofessional collaborative team. A collaborative process involving an interprofessional team developed a set of IH competencies for primary care. Team members represent nursing, primary care medicine professions, pharmacy, public health, acupuncture, naturopathy, chiropractic, nutrition, and behavioral medicine. Based on the IH competencies and needs assessment, a 35-h online interprofessional IH course, Foundations in Integrative Health (FIH), was developed. FIH is an online, self-paced, interactive experience. Experiential sessions were conducted at some sites. Trainees learn to conduct an IH assessment, learn from the other perspectives presented in the course and other trainees, and how patients are assessed and treated from each of the diverse professions as part of integrative primary care. Course material is presented with a focus on an interprofessional collaborative team approach and includes diverse case examples. Units include IH Introduction; Prevention and Lifestyle; Healthcare Professional Wellbeing; Addressing Patients through an Integrative Lens; Integrative Interventions; and Community Settings and Systems. The course was successfully pilot tested in primary care training programs, for example, residencies, nursing, pharmacy, oriental medicine, chiropractic, and community health centers. Six hundred seventy-nine trainees completed the course. Evaluation ratings were very positive. Two thirds reported incorporating new self-care practices. Positive changes were found on multiple well-being measures. Challenges and opportunities implementing FIH in primary care training programs targeting nursing, family medicine residents, and medical students will be presented. Experiences implementing the curriculum in community clinics will presented. Present and future initiatives utilizing the NCIPH course, and other resources will be discussed. Rationale: Evidence is accruing for the clinical and cost-effectiveness of IH care; however, there is a knowledge gap for primary care professionals, which has hindered widespread adoption of IH into health-care systems. IH advocates for person-centered health care that is informed by evidence and makes use of appropriate health-care professionals, disciplines, healing traditions, and therapeutic approaches. IH envisions a care process that is a team activity, with the patient as a central team member. This differs from prevailing patterns of care that are often compartmentalized, fragmented, and delayed. An IH team would employ professionals with a wide spectrum of expertise and skills and diverse, interdisciplinary education, and training in a set of core competencies. Health-care education efforts are often hampered by constraints of time, scheduling, and budget. Additional barriers, such as scheduling across disciplines, imbalances in professional group composition, lack of colocation, and larger than optimal group size, are also encountered in interprofessional education. An online course addresses the challenges of time, cost, location, and curriculum consistency and can be widely disseminated to the entire spectrum of primary care training programs and in clinical settings. Developing course materials using an online learning format acknowledges the global nature of primary care education and health-care systems. Objectives: The aim is to describe the FIH course and highlight evaluation findings, identify successful ways to incorporate all or part of the course into primary care educational programs and clinical settings, describe ways to use the course in community health centers to provide IH interprofessional development, and strategize ways to implement the FIH course in educational programs and/or clinical settings-based upon lessons learned in the FIH implementation. Outline: Dr Lebensohn will discuss the development and content of the FIH course, detailing the integrative interprofessional content and structure of the online course. Dr Brooks will provide an overview of the pilot study evaluation results. Drs. Klatt and Koithan will describe the lessons learned at their sites implementing the pilot, including necessary features for success, and encourage participants of the symposium to explore how this might be best utilized at their home institution. Drs. Kligler and Brooks will discuss applications of course in community health centers. The panel will discuss next steps for dissemination. Drs. Lebensohn and Maizes will moderate a discussion of challenges and opportunities implementing an interprofessional, integrative health curriculum. (2172) Inducing Therapeutic Lifestyle Changes for the Prevention and Treatment of (Mental) Disease Rogier Hoenders, MD, PhD1 1Center for Integrative Psychiatry, Lentis, Groningen, the Netherlands Abstract Overview: It has been estimated that if we pay more attention to specific aspects of diet, overweight, inactivity and smoking, we might prevent >90% of diabetes mellitus type 2, >80% of coronary heart disease, and >70% of colon cancer and stroke. There is also growing evidence for the efficacy of lifestyle changes for treating (mental) disease, but besides running therapy and mindfulness, therapeutic lifestyle changes in (mental) health care are seldom applied in clinical practice and seldom taught in medical curricula. A lifestyle program consisting of diet/nutrition, exercise, and relaxation has been proven effective for reversal of coronary heart disease and early stage prostate cancer. Promoting lifestyle changes is also an effective intervention for mental health. Besides improving heart disease, the Ornish program also diminishes depression symptoms by 50%. A recent randomized controlled trial showed a positive effect of a nutrition intervention when added to the treatment of depression. Running therapy seems effective for depression. In this interactive lecture, we will look at our modern nutrition, relaxation, and exercise habits, learn about the scientific evidence for therapeutic lifestyle changes, increase our awareness about our own lifestyle, and learn which bio-psycho-socio-ecological factors hinder long-lasting behavioral change, and we will practice how to overcome them using registration, motivational interviewing, a step by step approach, the stages of change model, and a lifestyle medicine attitude. Rationale: Despite important progress in psychiatry not all patients respond well to available treatments. Studies using data of both published and unpublished clinical trials show that the effects of the most common treatments in psychiatry have been overestimated. This seems to be true for psychotherapy as well as for the pharmacologic treatments of many major psychiatric disorders. In addition to growing concerns about efficacy, psychotropic drugs can cause adverse effects and may potentially increase suicide risk. Many patients are looking for other ways, specifically approaches they can apply themselves, leading to less stigma and empowerment. Besides, the costs of health care are getting out of control. One possible strategy to cut costs and to improve treatment outcomes is inviting patients to take a more active role in their recovery by learning them therapeutic lifestyle changes, such as nutrition, exercise, and relaxation. This appears to be cost effective, even cost saving. Objectives: The aim is to learn about the scientific evidence for improving (mental) health by inducing therapeutic lifestyle changes, increase awareness about one’s own lifestyle, learn about which bio-psycho-social-spiritual factors prevent us to achieve long-lasting behavioral change and how to overcome them, and be able to do a lifestyle anamnesis and coach patients in changing their lifestyle for better (mental) health. Outline: By changing our lifestyle, we can prevent and even treat (mental) disease Achieving long-lasting behavioral change is difficult By applying specific techniques, we can increase our success rate (2203) Engaging Nature for Health and Well-being: From Therapeutic to Therapy David Victorson, PhD1, Barbara Kreski, MHS, OTR, HTR2, Stacy A Bare, MCP3, Teresa H Horton, PhD4 and Frederick O Foote, MD5 1Chicago, Illinois 2Chicago Botanic Garden, Glencoe, Illinois 3Salt Lake City, Utah 4Northwestern University, Evanston, Illinois 5Baltimore, Maryland Abstract Overview: A continuum of therapeutic nature-based activities exists including adventure wilderness trips, equine therapy, forest bathing, and horticultural therapy. Practitioners and participants have compelling qualitative and quantitative findings regarding changes in function, affect, behavior, and biophysiological markers of stress that occur during and postintervention. However, acceptance of these activities as adjunct or complementary therapies within integrative medicine is limited due to a paucity of standardization of programs, research designs, methodologies, conceptual frameworks and definitions, and controlled research studies. Recent work strives to overcome these limitations. This panel discussion will introduce 4 program models that have been the subject of research that investigates the efficacy of and/or mechanism by which engaging with nature improves health and well-being. The panel will address the evidence that supports the use of these models as primary or complimentary interventions and for what conditions these interventions appear to be most effective. The discussion period will be used to identify ways to overcome barriers to the acceptance of nature-based therapies in integrative and complementary medicine. Rationale: Developing the evidence base needed to transition from the reported therapeutic effects of nature-based activities to the acceptance of these activities as adjunct or complementary therapies requires collaboration among multidisciplinary practitioners and researchers. Discussion of how practitioners and researchers can collaborate to support research to document the effects of nature-based therapies on specific patient populations, evaluate the efficacy and effectiveness of an intervention, provide comparisons to current practices, and identify specific health outcomes will facilitate this transition. Objectives: After attending this session, participants will be able to describe the spectrum of nature-based activities, identify the modalities by which nature influences physical and mental health, identify the patient populations that appear to be best suited for nature based therapies, recognize barriers that have impeded the widespread acceptance and incorporation of these therapies in health care, recommended assessment tools that could enable and facilitate research, and develop a research agenda for systematically approaching the need for evidence. Outline: 1 Introduction by moderator  • Introduce panelists  • Define key terms  • Introduce presentations by panelists 2 Panelists each (4) provide a video and explanation of their nature-based program 3 The moderator will set the stage for the panel discussion by briefly describing:  • The nature of illness, disorder, or malaise that appears to be most suitable to complimenting existing standard practice with nature-based therapeutics,  • the current state of evidence basis for nature-based therapeutics which is fledgling, and  • why this is a barrier to their more widespread use. 4 Selected panelists will address the points raised by the moderator  • Viewpoint from practitioners  • Viewpoint from practitioner/researchers  • Culminating in suggested research agenda 5 Moderator will open discussion to attendees and moderate discussion likely to include the following questions:  • People have different definitions of nature. Is a formal garden “natural”? Do images of nature count?  • Is not nature therapy simply a form of leisure therapy? How do you distinguish the 2?  • Can you define the scope of practice for “nature therapists”? 6 Moderator will summarize and conclude (3243) Development and Evaluation of Integrative Nutrition Education Programs for Schools, Underserved Neighborhoods, and the Military Diane Hannemann, PhD1, Patricia Deuster, PhD, MPH2, Elizabeth Moylan, MPH, RD, CSSD2, Christopher R D'Adamo, PhD3 and Brandin Bowden, MS1 1The Institute for Integrative Health, Baltimore, Maryland 2United States Uniformed Services University, Bethesda, Maryland 3University of Maryland School of Medicine, Baltimore, Maryland Abstract Overview: Stress coupled with limited exposure and access to affordable healthy foods influence food choices. Successful nutrition programming that inspires lasting behavior changes should be experiential and address social and economic barriers to healthy eating. This session will feature integrative nutrition and culinary programs designed to address specific communities, including underserved, schools, and the military. Integrative, well-being platforms need to incorporate life skills, such as stress management, nutrition, budget shopping, physical activity, and relationship building to maximize success. Evaluation methods include anthropometrics, perceived stress, food diaries, and sensory testing of foods, cooking habits, physical activity, sleep, and well-being. Discussions will include how these measures inform program dissemination and improvements and actionable federal and local policies that support access to affordable healthy foods. Rationale: Access to and knowing how to prepare healthy foods can benefit multiple communities—military, underserved, and many others populations. However, improving access and confidence in creating healthy meals requires cooking skills, nutrition knowledge, and contact with the soil. These are the key to improving community well-being and the food environment. This session will present several experiential, integrated nutrition and culinary programs that consider social and economic factors for each target community. Presenters will also discuss how program results can inform program improvements as well as policies to support access to affordable healthy food. Objectives: Upon completion, participants will be able to describe experiential nutrition education programs that promote healthy eating and life-skills development, demonstrate how important program evaluation is for improving future programs and policies supporting access to affordable healthy food, and translate how evidence from program evaluation can be used to develop actionable policies. Outline: • Nutrition and culinary programs need to address socioeconomic factors in target populations that present barriers to healthy food decisions. Experiential learning is motivating and allows development of practical nutrition and culinary skills. • Incorporating life skills into nutrition programs creates an integrative platform for well-being. • Program evaluation informs policies that support access to affordable and appealing healthy food. (3248) Integrative Medicine and Cancer Patient Self-care: A Simple Yoga/Progressive Muscle Relaxation Intervention for Patients to Practice at Home to Help Manage Treatment Side Effects, Enhance Quality of Life, and Improve Clinical Outcome Leigh Leibel, MSc1 and Kathleen Sanders, APRN, MSN, MPH2 1Herbert Irving Comprehensive Cancer Center, NYP-Columbia University Medical Center, New York City, New York 2Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington Abstract Overview: The objective of this interactive workshop is to share a simple and effective 15-min yoga/progressive muscle relaxation (PMR) technique that cancer patients may practice on a regular basis to help manage various physical and psychological side effects of the disease and its treatment. Common adverse sequelae include anxiety, fatigue, sleep dysfunction, neuropathy/balance issues, constipation/nausea, arthralgia, pain, and menopausal hot flashes. This is a nonpharmacological intervention that is easy for clinicians to learn and teach their patients, and it empowers patients by giving them an effective stress management tool that is enjoyable to practice at home on their own or with other family members, thereby increasing the incidence of daily compliance. This yoga/PMR technique is appropriate for the immunosuppressed, those at risk for lymphedema, those with decreased bone strength due to disease or treatment, and for patients with general deconditioning. The physical exercises described may be modified as necessary for functional limitations and may be performed in a bed or chair. This simple practice introduces cancer patients to a healthy lifestyle protocol that will help them thrive during active chemotherapy and radiation treatment, as well as successfully transition from patient to survivor. In this 75-min interactive workshop, we will introduce the technique (15 min), cite relevant research (15 min), practice the protocol as a group (15 min), discuss patient feedback and compliance (15 min), and propose techniques for implementation in clinic (15 mins). Handouts and links to video demonstrations will be provided. Rationale: Collaboration in action: Health-care providers empowering patients by teaching them a simple, drug-free alternative to manage side effects of cancer treatment! Yoga and PMR are mind–body techniques that cancer patients may practice on a regular basis to help manage various physical and psychological side effects of the disease and its treatment. Common adverse sequelae include anxiety, fatigue, sleep dysfunction, neuropathy/balance issues, constipation/nausea, arthralgia, pain, and menopausal hot flashes. The technique is a nonpharmacological intervention that is easy for clinicians to learn and teach their patients, and it empowers patients by giving them an effective stress management tool that is enjoyable to practice at home on their own or with other family members. It is appropriate for the immunosuppressed, those at risk for lymphedema, those with decreased bone strength due to disease or treatment, and for patients with general deconditioning. The physical exercises described may be modified as necessary for functional limitations and may be performed in a bed or chair. This simple yoga/PMR practice introduces cancer patients to a healthy lifestyle protocol that will help them thrive during active chemotherapy and radiation treatment, as well as successfully transition from patient to survivor. Objectives: This is a simple, nonpharmacological intervention that is easy for clinicians to learn and teach their patients during an office visit. Significantly, the clinician is able to offer the patient a drug-free alternative to ameliorate cancer treatment side effects. As well, it empowers patients by giving them an effective stress management tool that is enjoyable to practice at home on their own or with other family members, thereby increasing the incidence of daily compliance. Outline: In this 75-min interactive workshop, we will introduce the technique (15 min), cite relevant research (15 min), practice the protocol as a group (15 min), discuss patient feedback and compliance (15 min), and propose techniques for implementation in clinic (15 mins). Handouts and links to video demonstrations will be provided. (3348) Developing and Implementing a Successful “Medical Yoga” Program as a Part of Integrative Care for Multiple Chronic Illnesses—Approach, Capabilities Required, Integration Into Clinical Practice, and Benefit Summary From VA New Jersey Health Care System 2-Year Experience Ann C Cotter, MD, FABPMR, CNS1, Jayashree S Pathak, MBBS(MD), C-IAYT, PGDYTD, DYEd1 1East Orange, New Jersey Abstract Overview: The VA Whole Health System includes clinical care that supports veteran self-care in both veterans who seek prevention and those who suffer from multiple chronic illnesses. Yoga therapy uses the science of yoga to help patients harness their inherent homeostatic forces. Many integrative care facilities across the United States and world have begun to incorporate yoga therapy for a variety of medical conditions. Oftentimes, the yoga therapy being implemented is labeled by a discipline “Hatha,” “Vinyasa,” “Iyengar,” and so on. Published research has reported a range of results from such implementations. It is important to develop a patient-centered and therapy-focused yoga program which first and foremost answers the questions of Why is yoga useful? What practices should be done? How do these benefit the patients? In-depth knowledge of the field of medicine coupled with the knowledge and experience of yoga are critical enablers for developing and implementing a successful yoga program within integrative care. This workshop session is aimed at practitioners and administrators who are looking to implement or increase the efficacy of yoga within their integrative health care. The workshop would also be of interest to the academic institutions that are looking to incorporate yoga-related education as a part of their curriculum in undergraduate medical school, residency training, and grand rounds lectures. Rationale: Chronic diseases are common, costly, and debilitating. According to Centers for Disease Control and Prevention, 1 in 4 Americans has multiple chronic conditions. As the number of conditions increase so does the cost of care. About 71% of total health care spending in the United States is associated with chronic care for more than 1 condition. A chronic disease process signifies a state of prolonged maladjustment and is brought about by a range of factors such as clinical, social, psychological, economic, and familial. Increasingly, integrative care is being adopted as a way of addressing a number of chronic conditions. Yoga is a scientific and practical discipline that helps in regaining and maintaining the state of homeostasis in the face of disturbances. Yogic practices bring about integration of psychophysiological processes. Effectively incorporating yoga therapy in integrative care has the potential to significantly improve patient’s quality of life, reverse some of the underlying causes for the chronic conditions while reducing the overall cost of care for patients as well as the society. Objectives: The participants will discuss key principles of yoga from a medical/scientific point of view, get help for developing a program that could potentially be used for triaging and inducting chronic care patients in medical yoga, learn strategies to integrate yoga therapy into multidisciplinary care, identify an overall outline of a medical yoga therapy program for general chronic conditions and some specific medical conditions, recognize the importance and contents of the introductory first 2 sessions which are critical for successful outcome, participate in medical yoga practices along with explanation for these, get to know the outcome from a 2-year 200 patient implementation of the program at VA New Jersey Health Care System (VANJHCS), and assess best practices that can be deployed, challenges in implementation and ways to mitigate these. Outline: Following key topics would be covered in the experiential workshop: • Integrative care program—an implementation approach from VANJHCS • Medical yoga—a medical/scientific perspective • Medical yoga therapy program for multiple chronic conditions—implementation approach • The first 2 sessions—critical success enablers • Experiencing medical yoga Practices along with why, how, and what not to do • Qualitative patient-centered feedback • Additional use cases: inpatient psychiatry and substance use • 200-patient feedback from the implementation at VANJHCS • Where can we further improve—preventive and acute conditions • Question and answer (3387) A Process for Facilitating Lasting Transformational Change Through Phoenix Rising Yoga Therapy Using the Lens of the Memory Reconsolidation Process Rickie T Simpson, PHD APRN-CNS, C-IAYT1, Michael Lee, MA, Dip.Soc.Sci, Dip.T., C-IAYT, E-RYT 5002 1Stratford University, Manassas, Virginia 2Phoenix Rising Yoga Therapy, Great Barrington, Massachusetts Abstract Overview: Clients often come to session with behaviors that are baffling. In the context of past suffering, these behaviors often makes a lot of sense to the brain’s implicit memory that is predicting and acting globally to current experiences as if in the past. If formed in the presence of strong emotion, these responses can be extremely durable. For 30 years, Phoenix Rising Yoga Therapy has employed a refined embodied present-centered focus through which the past is experienced differently than the original event. This “lens” change is highly effective in alleviating the suffering caused by past trauma with lasting results. Rationale: Although yoga is not in its infancy, yoga therapy as an integrative mind–body therapy is. Understanding how effective lasting change can be experienced through an embodied present-centered focus will be helpful to therapist of many modalities. This workshop will endeavor to explain and demonstrate this by referencing the memory reconsolidation process, yogic philosophy, and the essence of mindfulness. Objectives: The aim is to identify the steps of the memory reconsolidation process in supporting the use of an embodied present-centered focus to support the brain’s natural transformational process and participate in a Phoenix Rising guided process to experience working directly with embodied present-centered awareness. Outline: 1. What is the memory reconsolidation process and the necessary steps for consistent transformational change. 2. Creating an effective embodied and present-centered experience referencing yoga philosophy, mindfulness, and recent neuroscience. 3. Guided experience. 4. Discussion. (3414) Fascia: The Missing Link in Mind/Body Interventions David Lesondak, BCSI, AS1 1Pittsburgh, Pennsylvania Abstract Overview: What if one of the keys to mind/body medicine was under our fingertips all along? Given the recent revelation that the fascial network has over 100 million sensory nerve endings, it seems quite likely. Fascia is both a tissue and a system. As such, fascia interacts uniquely with all the other systems of body, influencing not just pain perception, but also proprioception, interoception, and perhaps even neuroplasticity. Learn the latest facts from one of the chief documentarians of fascia science over the last decade. Rationale: The tremendous leap forward in fascia science have been occurring through collaboration among clinicians and researchers. Incorporating fascial modalities is still an outlier in most integrative medicine centers while public awareness of fascia is moving toward a tipping point. It is important that the integrative professional have a clear understanding of what fascia is and why it matters so that they can be able to intelligently guide their patients and improve outcomes. Objectives: The aim is to understand the role of fascia as both a tissue and a system in the body, recognize fascia as the body’s largest sensory organ, learn the clinical significance of fascia in chronic pain, gain insight to the role of fascia in mind/body interventions, and identify what skills are needed in a good fascial practitioner. Outline: 1) Fascia as a tissue and its influence on biomechanics. 2) Fascia at the cellular level as an initiator of mechanotransduction (via integrins and stretch). 3) Fascia as a bodywide cellular communication network (via telocytes). 4) Fascia as the body's largest sensory network. 5) Identifying fascial pathologies. 6) Key qualities for fascial practitioners. (3454) Homeopathy in Public Health, Safety, and Plausibility Bias Peter A Fisher, MD1 and Michelle L Dossett, MD, PhD, MPH2 1Royal London Hospital for Integrated Medicine, London, UK 2Massachusetts General Hospital, Boston, Massachusetts Abstract Overview: The conclusions of systematic reviews of randomized controlled trials (RCTs) of homeopathy vary from “comparable to conventional medicine” to “no evidence of effects beyond placebo.” Analysis of 4 “authoritative” reports reveals major methodological and/or procedural flaws that negatively bias their conclusions on homeopathy. Examination of the prior beliefs underlying this standoff can advance the debate. Moreover, data from rigorous RCTs, meta-analyses, and clinical effectiveness studies of the use of homeopathy for respiratory tract infections, mental health, and pain conditions showing evidence of clinical and public health benefit will be examined. Use of homeopathy to reduce the growing problem of antimicrobial resistance will be discussed, and data on the safety of homeopathy will be presented. Rationale: Homeopathy is a highly contested but widely used whole medical system. Some authorities have made sweeping statements about the scientific impossibility of homeopathy without appropriate examination of the evidence, an approach which is in itself unscientific. Careful examination of the methodology used and underlying assumptions leads to greater understanding in this debate. Focusing on well-conducted, peer-reviewed studies of homeopathy in upper respiratory tract infections, mental health, and pain conditions, the potential for homeopathy to advance public health will be discussed. Recent concerns regarding safety will also be addressed. Objectives: The aim is to identify and describe major methodological and procedural flaws in 4 recent authoritative reports on homeopathy; understand the global problem of antimicrobial resistance, interpret results of RCTs, meta-analyses, and clinical effectiveness studies of homeopathy for respiratory tract infections, and describe the role of homeopathy in combating antimicrobial resistance; interpret RCT data, meta-analyses, and clinical effectiveness studies on the use of homeopathy for mental health and pain conditions; and understand data on the safety of homeopathy. Outline: 1. Introduction—What is homeopathy and what is the controversy? 2. Examination of recent reports reviewing clinical effectiveness of homeopathy 3. Review of the problem of antimicrobial resistance and data on homeopathy for upper respiratory tract infections 4. Review of studies using homeopathy for mental health and pain conditions 5. Review of safety data on homeopathy, including recent Food and Drug Administration action 6. Questions and answers (3455) The Impact of Objective Mindfulness Practice Adherence on Mindfulness-based Intervention Outcomes Among High-stress Populations Michael Christopher, PhD1, Helané Wahbeh, ND, MCR2, Letícia Ribeiro, MS1, Candice Hoke, MS1, Mathew Hunsigner, PhD1, Richard Geoerling, MBA2, Barry Oken, MD, PhD2, Cindy Gross, PhD2 and Dana D Colgan, PhD2 1Pacific University, Hillsboro, Oregon 2Portland, Oregon Abstract Overview: Repetitive exposure to high levels of critical incidents, the need to respond promptly with precision and accuracy, and high expectations of optimal performance all contribute to high levels of stress among police officers, physicians, and military personnel. Chronic stress has been shown to adversely affect physical and mental health and has been linked to diminished performance. Mindfulness-based interventions (MBIs) have demonstrated effectiveness in minimizing the damaging consequences of chronic stress among high-stress populations. An important factor influencing MBI outcomes is treatment adherence. Adherence data are important because they elucidate the extent to which adhering to an intervention influences the outcomes of interest. Several studies have documented that participants who endorse more (duration and frequency) mindfulness practice are more likely to have better outcomes. This symposium will present data on the relationship between objective adherence to formal mindfulness practice and health-related outcomes in separate randomized controlled trial MBIs among samples of law enforcement officers, physicians, military veterans, and stressed older adults. All of the studies used iMINDr, a custom software application developed for iPod Touch, that objectively tracks home formal mindfulness practice adherence. Additionally, the relationship between self-reported informal mindfulness practice and health-related outcomes will be presented. Participants in the studies exhibited improvement across several health-related outcomes following the MBI when compared to waitlist controls. Participants generally reported that iMINDr was acceptable and easy to use. Among high-stress populations, different relationships among objective formal mindfulness practice, informal mindfulness practice, and MBI outcomes, including increased resilience and reduced anger and aggression, emerged. The impact of mindfulness practice adherence on MBI outcomes will be discussed as well as preferred practices among these highly stressed populations. Developing culturally sensitive delivery models that increase practice adherence within these populations will also be explored. Rationale: An important and especially salient factor influencing MBI outcomes is adherence to treatment. Adherence data are important because they elucidate the extent to which adhering to an intervention influences the outcomes of interest. Adherence to mindfulness practice is usually assessed through self-report, which limits the accuracy of these findings. Exploring new methods of objectively measuring adherence is critical to our understanding of these practices. In addition to objective assessment of adherence, future research should investigate culturally sensitive delivery models that foster greater mindfulness practice adherence among diverse populations. Objectives: The aim is to discuss the benefits and obstacles of objectively tracking home mindfulness practice adherence; examine the relationships between objective adherence to formal mindfulness practice, informal mindfulness practice, and health-related outcomes following MBI among law enforcement officers, physicians, military veterans, and stressed older adults; learn about the preferred mindfulness practices as well as perceived supports and barriers to practice among highly stressed populations; and explore culturally sensitive delivery models that foster out of session adherence to mindfulness practice. Outline: Presentation I Title: Objective adherence to meditation interventions in multiple stressed populations Authors: Helané Wahbeh, ND, MCR and Barry Oken, MD, PhD Adherence data are important because they elucidate the extent to which adhering to an intervention influences the outcomes of interest. Drug trials regularly use Medication Event Monitoring System and pill counts as objective adherence measures. No such standards exist in mind–body medicine research. In mind–body medicine, there are 2 intervention aspects that can be measured for adherence: class/instruction and home practice. Instruction adherence can be easily collected through attendance records; however, these are rarely reported. Adherence to home practice is usually assessed through self-report. Although this is an improvement from not measuring home practice adherence at all, it has limitations. First, self-report adherence data are rarely reported. Second, self-report diaries are subject to errors and poor accuracy. Results based on self-report home practice logs must be interpreted with caution because there are no objective measures validating their accuracy. Not assessing objective adherence is an important problem because any results from an intervention that includes home practice will have an element of uncertainty due to the unknown parameter of how much the subjects practiced at home. We developed iMINDr, a custom software application for use with an iPod Touch, to accurately and objectively track home practice adherence. iMINDr collects all actions performed (date, time, action [start, stop, pause, volume change]). We have now collected iMINDr data in multiple meditation studies in stressed older adults, older adults with depression, and combat veterans with post-traumatic stress disorder (PTSD). Unexpectedly, subjective and objective reports of adherence were highly correlated. Average adherence levels ranged from 0 to 30 min per day. Adherence was a significant covariate in multiple outcomes of the PTSD study. Challenges in supporting meditation intervention adherence in stressed populations and the benefits of having an objective adherence measure will be discussed. Presentation II Title: Adherence to informal, but not formal, mindfulness practice correlates with resilience and team cohesion among interdisciplinary primary care teams Authors: Dana D Colgan, PhD and Michael Christopher, PhD Increasing rates of burnout among primary care providers pose a serious threat to the health-care system. MBIs have been shown to reduce burnout and enhance quality of life among primary care physicians and nurses; however, a commonly reported limitation of MBIs among health-care providers is high attrition rates due to the intensive time requirement typically associated with MBIs. To address this concern, mindfulness-based wellness and eesilience (MBWR) was developed and designed to increase resilience and decrease burnout. MBWR is provided to intact primary care teams (IPCT) and delivered onsite, during paid, protected time. Mindfulness practice adherence was collected from participants in a controlled trial evaluating the preliminary efficacy of MBWR (n = 38). Participants assigned to the MBWR condition (n = 21) were given an iPod Touch device with the software application iMINDr, developed to accurately track formal mindfulness practice. Informal practice data were collected weekly with a brief self-report questionnaire. Posttraining surveys gathered practice preferences and perceived supports and barriers to practice. A multilevel modeling approach yielded significant improvements in the MBWR group at post- and 3-month follow-up in several outcomes, including mindfulness, resilience, and team cohesion. Frequency of informal mindfulness practice was significantly correlated with multiple outcomes, including post-MBWR (r = .55; P = .03), nonjudgmental awareness (r = .54; P = .04), and team cohesion (r = .52; P = .05), and 3-month follow-up scores in resilience (r = .57; P = .03). Attendance and adherence to formal practices were not significantly correlated with post-MBWR or 3-month follow-up outcomes. Preferred mindfulness practices will be reported as well as perceived supports and barriers to practice adherence. Providing opportunities for IPCTs to train together and create tailored, authentic workflows that incorporate informal mindfulness practices may bolster individual mental immunity as well as develop and sustain a culture of mindfulness-based resilience within the primary care work environment. Presentation III Title: Adherence to formal and informal mindfulness practice correlated to reduced aggression and improved resilience among law enforcement officers Authors: Leticia Ribeiro, MS, Dana D Colgan, PhD, Candice Hoke, MS, Lt. Richard Geoerling, MBA, Matthew Hunsinger, PhD, Barry Oken, MD, PhD, and Michael Christopher, PhD Law enforcement officers (LEOs) are regularly exposed to critical incidents, leading to high levels of stress and burnout. Stress and burnout among LEOs have been linked to a number of negative outcomes, including aggressive behavior and excessive use of force. Mindfulness practice has shown to effectively reduce both stress and negative affect among highly stressed populations. Several studies have shown higher frequency and duration of practices are related to better outcomes, suggesting that the effectiveness of MBIs is at least partially accounted for by mindfulness practice. In the current study, LEOs (n = 61) were randomly assigned to an 8-week MBRT, or a waitlist control, and assessed at baseline, post, and 3-month follow-up. Participants in the MBRT condition had their adherence to formal mindfulness practice (FMP) tracked by a software application (iMINDr) installed on an iPod Touch lent to participants during the MBRT intervention. Informal mindfulness practice (IMP) was collected through weekly self-reports. A multilevel modeling approach yielded significant improvements in the MBRT group in several outcomes at posttraining, including aggression (P = .05, d = .53), burnout (P < .01, d = .73), and alcohol use (P = .02, d = .37). MBRT participants engaged in an average of 322 min of out-of-class FMP, and practiced an average of 10 min of per day. Participants also endorsed practicing a number of IMPs throughout the study. Baseline to 3-month follow-up residualized change scores in aggression were negatively correlated with both frequency (r = −48; P = .013) and duration (r = −.45, P = .021) of FMP. IMP was negatively correlated with baseline to post-MBRT residualized change scores in aggression (r = −.60, P = .031), anger (r = −.78, P = .013), and positively correlated with resilience (r = .67, P < .001). Implications regarding specific practices predicting outcomes following mindfulness interventions in this population will be discussed. (3479) Designing Mind–Body Intervention Trials: Information Sources That Can Be Useful Terry K Selfe, DC, PhD1 and Terry K Selfe, DC, PhD1 1University of Florida, Gainesville, Florida Abstract Overview: This session, aimed at those new to Complementary and Alternative Medicine research, will present randomized, controlled trial (RCT) design basics, with an emphasis on mind–body studies, and some information sources that can be used to facilitate study design. You will learn to locate reporting standards that exist for various study designs and use them to enhance your study; formulate answerable research questions; find outcome measures and supportive resources to improve instrument selection and interpretation; and recognize and address issues specific to studies of integrative therapies. Combining lecture and small group workshops, the goal of this session is to present information that will make designing a controlled trial less intimidating and more manageable; thus, empowering novice researchers to begin designing and conducting clinical trials, and strengthening the skills and knowledge base of those already engaged in human subjects research. While this content will be presented with a focus on its application to research design, it will also be useful to clinicians and educators who want to improve their ability to search the literature, retrieve pertinent articles, and assess the quality of the studies. Rationale: Developing a strong evidence base is critical to advancing the field of integrative medicine and health. This requires high-quality research studies. Like many other professional fields, many clinicians receive little research training during their formal education. In this session, I will present content that has been drawn not just from my research training, but also from my library science background, and aimed primarily at enhancing research design knowledge. My background as a clinician, researcher, and librarian has given me a unique, cross-disciplinary perspective and enabled me to see how knowledge from one domain can be used to advantage in another. The goal of this session is to present content from both research and information fields that will make designing an RCT less intimidating and more manageable, thereby empowering novice researchers to begin designing and conducting research, strengthening the skills of those already engaged in research, and ultimately advancing the field. Objectives: As a result of this session, attendees will be able to locate and utilize reporting standards for their research design; form a searchable research question using the population, intervention, comparator, outcomes (PICO) framework; discuss studies in the context of the PICO framework; locate and utilize outcomes instruments and related materials; and recognize and address some design issues specific to mind–body research. Outline: Introduce reporting standards, where they can be found, and their usefulness in the study design phase Briefly present PICO framework: population, intervention, comparator, and outcomes Discuss challenges specific to mind–body intervention studies (eg, blinding, selecting an appropriate comparator) Present information on outcomes instruments, information sources to check to find the instruments, and the importance of locating the actual instrument and reviewing the questions, scoring instructions, normative values, and any clinically important differences Break into small groups: • Participants will work on developing a PICO question • Using prompts provided by instructor, the groups will discuss issues and brainstorm ideas related to each PICO component Reconvene and briefly discuss common and divergent ideas generated by small groups (3490) Earthing (Grounding)—Rediscovery of Nature’s Oldest Healing Modality: Introduction to the Science, Clinical Evidence, and Practice of “Earthing” James Oschman, PhD1, Richard M Kotz, MA2, Gaetan Chevalier, PhD3, Tracy Latz, MD3 and Stephen Sinatra, MD3 1Nature’s Own Research Association, Dover, New Hemisphere 2North American Science Associates, Potomac, Maryland 3Manchester, Connecticut Abstract Overview: Throughout virtually all of history, humans have lived grounded—connected to the Earth, that is, until man started sleeping on raised beds and walking on wooden and carpeted floors. Then, beginning in the 1960s with the advent of rubber or synthetic soled shoes which are insulators, we became less grounded. Now most of us are rarely in direct contact with the Earth except on those rare excursions to the beach. Why is this important? Because we are separated from what may be the world’s original healing resource: the planet itself and the unlimited supply of free electrons it provides. These electrons may be critical to our ability to reduce the inflammation that is afflicting our bodies. Inflammation caused by electron-scavenging free radicals is recognized as a major contributor to virtually every chronic disease as well as the diseases of aging. This leads us to the question of whether chronic inflammation in humans is exacerbated by their lack of connection to the Earth. We now have clinical evidence that grounding (reconnecting to the Earth) can reduce inflammation and pain, thin the blood and improve blood flow, promote healthier cortisol and blood sugar levels, and balance the autonomic nervous system. These and additional effects are documented in well over 20 peer reviewed journal articles (http://www.earthinginstitute.net/research/). In addition, many observational reports describe benefits for multiple sclerosis (MS), lupus, epilepsy, arthritis, peripheral artery disease, arrhythmia, premenstrual syndrome, insomnia, and other medical conditions. In this session, we will discuss the importance of reconnecting to the Earth, explain the theory and science behind grounding, present clinical evidence supporting its benefits, and demonstrate how it can easily and conveniently be incorporated into our lives. There will also be an opportunity for individuals at this session to experience “Earthing” firsthand. Rationale: Through the collaboration of scientists in the fields of engineering physics, biophysics, cell biology, cardiology, rheumatology, psychiatry, and clinical trials, the role of grounding or “Earthing” on human health has been developed and elucidated. The results of these collaborations have been presented in over 20 peer-reviewed articles (http://www.earthinginstitute.net/research/). Man’s lack of connection to the Earth and this breakthrough discovery of the Earth’s ability to heal could have profound impact on the prevention and treatment of many of the inflammatory diseases which are epidemic in our society and on the way we conduct animal studies (currently in ungrounded cages). We currently have observational evidence that it may lead to successful amelioration of currently poorly treated medical conditions such as arthritis, MS, lupus, Parkinson’s disease, some hormonal imbalances, peripheral artery disease and cardiac arrhythmias, among others. This session will also point out the importance of continued research on the clinical benefits of Earthing and potential models for conducting such research. Objectives: The participants of this sessions will understand the physics and electrophysiology of Earthing, be introduced to the current state of clinical evidence supporting Earthing, learn how to use Earthing as an integrative modality in their clinical practices, be exposed to the wide variety of clinical research that still needs to be done and potential models for conducting studies/trials, and experience Earthing firsthand. Outline: I. Physics and electrophysiology: 1) Why the Earth is a huge reservoir of electrons. 2) How humans have lost their connection to the Earth 3) Why this lack of connection is detrimental to electrophysiological and biochemical functioning II. Clinical evidence: studies showing 1) Cardiovascular effects 2) Rheumatological effects 3) Neurological effects 4) Other systemic effects III. Practice of this modality 1) How individuals can easily practice Earthing naturally and/or utilizing alternative technologies 2) How practitioners can guide their patients depending on medical condition/diseases IV Future clinical research: 1) Lupus, MS, Parkinson’s, atrial fibrillation, and so on. 2) Clinical research models: research paradigms and study designs IV. Audience will be able to experience grounding during the symposia if desired (3493) Experiences of an Interdisciplinary Online Fellowship Marni Hillinger, MD1, Darshan Mehta, MD, MPH2, Erika Cappelluti, MD, PhD3 and Tabatha Parker, ND4 1Vanderbilt University, Nasvhille, Tennessee 2Massachusetts General Hospital, Boston, Massachusetts 3Hartford Healthcare Cancer Institute, Hartford, Connecticut 4Academy of Integrative Health and Medicine, La Jolla, California Abstract Overview: Integrated medicine is now a board-certified specialty under the American Board of Physician Specialties. With the recently created American Board of Integrative Medicine (ABOIM), there is now a requirement for individuals to pursue a fellowship training program to sit for the board examination to qualify for board certification. As such, there are very few training options for health-care providers. In this panel discussion, we discuss the recently created Academy of Integrative Health and Medicine (AIHM) fellowship, as an interprofessional option for providers to learn through a community-based online learning program. Rationale: As the theme of this year’s conference is collaboration in action, this fellowship model presents a cross-disciplinary and interdisciplinary approach to community learning. We present a learning model that incorporates fellows from conventional and allopathic health-care professions, as well as naturopathic, chiropractic, and other licensed health-care professions from nonallopathic traditions. Objectives: The aim is to understand advantages and challenges to distance learning programs using adult learning theory, hear from panelists the challenges to participating in this type of interdisciplinary learning model, and understand the process of board certification in the field of integrative medicine. Outline: The panel will be opened by the fellowship director, who will describe the current structure of the AIHM fellowhip and its historical origins. She will help set the context of the ABOIM certification process and describe some of the challenges that have emerged in the creation of the fellowship (10 min). This will be followed by presentation from the other panelists of • Dr Parker will share more on the technology platform used in the AIHM fellowship, and the challenges of creating and maintaining curriculum for an interprofessional set of learns (10 min). • Dr Capelluti will discuss the benefits and challenges of having a clinical immersion experience that serves the interprofessional audience (10 min). • Dr Mehta will discuss some of the burnout issues that fellows face in completing a robust curriculum over a 2-year period (10 min). • Dr Hillinger will provide her firsthand experience as a current fellow as well as unexpected challenges in completing this curriculum (10 min). This will leave time for limited discussion in a 60 min panel. We would prefer 90 min or at least 75, for more dialogue with the audience, and the potential to expand one or more of the talks to 12–15 min. (3498) Bridging the Gaps of Integrative Medicine Between the United States and China to Enhance Collaboration in Achieving Better Health Care JianPing Liu, PhD1, Lixing Lao, PhD2, Ka-Kit Hui, MD4 and Weijun Zhang, DrPH4 1Beijing University of Chinese Medicine, Beijing, China 2University of Hong Kong, Hong Kong, Hong Kong 3Los Angeles, California Abstract Overview: There is growing interest worldwide in the development of integrative medicine (IM) to improve patient care and the health of population. In 2008, Health Ministers in China and the United States signed a memorandum of understanding (MOU) to foster collaboration among scientists and clinicians in both countries for IM research, which many believe would “improve the health of the American and Chinese people.” However, our previous interviews with IM experts in both countries indicated there is still a gap in understanding of IM among both experts at the individual level and academic institutions at the organizational/system level. These leading factors are currently hindering effective collaboration. In this symposium, speakers from both countries who are experienced in IM systems will share their knowledge and experience about differences in IM modalities, poractice, and research in order to strengthen future collaboration. Rationale: The current conference theme is to improve health care through better collaboration among IM experts and institutions in research, education, and clinical practice. Chinese integrative medicine and Western integrative medicine are 2 leading IM systems. However, clinical practice and research focus in these 2 systems have shown many differences in areas such as workforce, characteristics considered in research design, the range of commonly seen diseases/conditions, modalities utilized in clinical practice, guideline development in clinical practice, and so forth. A better appreciation of IM development in China will broaden the knowledge base for IM experts outside of China as well and facilitate collaboration worldwide. Objectives: Upon completion of the session, participants are expected to be able to understand essential features/approaches of integrative medicine in China and the United States, understand evidence-based practice and unique characteristics of research design in Chinese integrative medicine, describe the clinical practice of integrative medicine in hospitals and community facilities in China, and apply potential approaches for better advancing integrative health care through collaboration among experts and organizations of integrative medicine in both China and the United States. Outline: Introduction: the approaches of integrative medicine in China and differences from integrative medicine in the West Topic 1: How can research design represent both scientific rigor and characteristics of Chinese integrative medicine? Topic 2: Integrative medicine practice in hospitals and community facilities in China Topic 3: How can experts and organizations of integrative medicine in both China and the United States collaborate effectively? (3523) Pain Freeing Qigong and Meditative Techniques CJ Rhoads, DEd1 and Elaine Mendelsohn, RN, BSN, LMT2 1Kutztown University, Kutztown, Pennsylvania 2HealthSouth Rehabilitation Hospital, Reading, Pennsylvania Abstract Overview: It is often difficult for integrative health practitioners and professionals to understand the physical and mental pain of their patients. Providing effective solutions is even harder. This workshop will discuss the challenges of pain management, while at the same time providing practical and timely treatment options for chronic pain. The participants will come away with a greater understanding of the evidence-based research as well as practical hands-on menus of options to implement with their patients. One of the presenters has lived with chronic pain since November 5, 2002, when injured in a devastating car accident. In order to get out of severe, unrelenting pain, the presenter cracked the code of how pain works, and learned to short circuit the pain mechanism so that the pain can be ignored. The presenter now lives a full, productive, successful life. The experience has resulted in a dedicated focus on sharing the lessons of pain freeing activities with others who are suffering from unrelenting pain. This experiential workshop will go into depth about the pain mechanisms and the different aspects necessary in order to free the person from pain. While the lesson is scientific and biology-based, the presenter will utilize the ages-old methodology of qigong as a model of delivering the lesson. The qigong serves as a mnemonic to the activities necessary to stay out of pain and live a healthier, fuller, life. In an iterative cycle, the qigong becomes both the reminder and the method, as it forms one piece of the puzzle for solving the sticky wicket of unrelenting ideopathic pain. The other important aspect of pain relief is meditation activities. One of the presenters has trained extensively in pain relief utilizing meditation and has successfully treated patients using this pain freeing activity. Rationale: Pain management is one of the most difficult issues for modern medicine. Modern models of pain mechanisms are built upon earlier models such as Melzack and Wall’s Gate Control Theory which became popular in 1965. Earlier in the century, the medical community recognized only direct modality pain signals. In other words, physicians did not consider sensory perception of pain. They also did not recognize the adjustment of the nervous system to stimuli that previously did not cause pain but then would begin to cause pain inexplicably. Doctors would simply ignore pain for which they could not find a cause, as if it did not exist. Rather than recognize only pain with a specific ideology, Melzack explained how and why pain can cause itself and become the modality. Melzack recognized the important relationship between pain and stress. He was among the first to realize the powerful therapies available to decrease tension (relaxation) and the variety of ways to decrease pain intensity and break the pain-stress feedback loop which underlies so much chronic pain. He used the term neuromatrix to describe any particular individual’s experience of pain. More and more, the medical community is recognizing that neuroplasticity, with its ability to change the structure and function of the nervous system itself, may be essential to decrease intractable chronic pain. The brain chemistry requires changes to alter an individual’s sensitization and modulation of pain, particularly pain that no longer has an objective pain stimuli. Another useful paradigm in conceptualizing and understanding pain issues is the biopsychosocial model. This model uses a multidimensional framework to describe the relationship between physical, psychological, and social factors that influence the type, severity, and presentation of pain. Many factors must be considered when assessing and treating pain; history, emotions, family status, and numerous other variables. Unfortunately, these models and theories of pain are relatively new and are sometimes unknown by currently practicing physicians. There is sometimes a tendency among primary care physicians to dismiss complaints of pain, especially when no physical pathology can be identified. This has begun to change. One influence that has spurred more research and development into this area is returning veterans who have a very high incidence of chronic idiopathic pain. Even more importantly, however, it is often difficult for people in pain to trust in someone who has never been in severe unrelenting pain. The spector of “not being believed” is always hanging over the patient’s shoulder, seeking out more costly and more dangerous solutions. This behavior actually becomes part of the modality itself. One way to break this cycle is to listen and learn from someone who has been there; someone who has spent many months addicted to opiates to deal with the pain, and then found a way to manufacture their own opiates within their own body chemistry in order to decrease the amount of pain felt. This workshop will introduce the practitioner to such a person and enable them to learn from those experiences. Objectives: This experiential workshop will present both the medical mechanism of pain as well as a case-study type solution to severe unrelenting pain. The format of the lesson is presented as a mnemonic qigong which both serves as one aspect of the pain relief mechanism and reminds the patient of all the aspects of the pain freeing activities. The participants will be able to understand the physiological pain mechanisms within the body, recognize the pain-relieving mechanisms of mind–body practices such as qigong and meditation and explain how they work, explain to others about the pain freeing mechanisms of several different lifestyle activities, demonstrate a simple-to-reproduce qigong and meditative activity that provides both an aspect and a reminder of those pain-relieving mechanisms, utilize an educationally proven methodology to teach patients and clients methods for their own pain relief, and know how to follow the pathway to sharing the educationally proven methodology with others. Outline: 1. The physiological pain mechanisms within the body.  ○ About the pain network and how the different parts contribute to pain, including how acute pain can become chronic pain.  ○ An appreciation for the development of chronic pain as a lifestyle disease and an understanding of the causes and reinforcement of pain.  ○ About biopsychosocial models of pain, reinforcement and extinction of pain, partner influences, stress influences at work, in the family, at home, and during free time. 2. The pain-relieving mechanisms of mind–body practices such as qigong and tai chi and how they work.  ○ The connection between the parasympathetic nervous system and the pain-influencing nerve cells.  ○ The connection between brain waves and the parasympathetic nervous system.  ○ The connection between stress-reducing activities and brain waves.  ○ Overarching information on utilizing new technologies to help patients in pain. 3. The pain freeing mechanisms of several different lifestyle activities.  ○ About biopsychosocial models of pain, reinforcement and extinction of pain, partner influences, stress influences at work, in the family, at home, and during free time.  ○ The difference between health and unhealthy behaviors, cognitions, and feeling.  ○ Pioneering ways to help patients feel less tired and depressed despite acute or chronic pain.  ○ About the role of cannabis; Is it a novel and much needed solution, or a wayward path?  ○ Original research on cost effectiveness of various treatments for pain. 4. A simple-to-reproduce qigong that provides both an aspect and a reminder of those pain-relieving mechanisms.  ○ Pain mechanism forms  ○ Pain freeing forms  ○ Dosage in frequency and intensity 5. An educationally proven methodology to teach patients and clients methods for their own pain relief.  ○ Social aspect of group practice  ○ Importance of frequency  ○ Importance of imagery  ○ Backed by research  ○ Importance of support  ○ Supporting the journey 6. The pathway to sharing the educationally proven methodology with others.  ○ Innovative ways to communicate to patients the pain mechanisms so that they can understand how pain management works—and which ones will work best for them.  ○ Novel ways of helping patients understand the important connection between strength, energy, flexibility, nutrition, emotional states, hormones, and their pain levels.  ○ How to distinguish physiological subgroups and the necessity to vary treatment based upon subgroups of pain patients.  ○ Special concerns when it comes to helping seniors in pain.  ○ Special concerns when it comes to helping cancer patients in pain.  ○ Review of the groundbreaking research on methods to enable patients to live a longer, healthier, happier life (methods that can help the practitioner as well!).  ○ Discussion of the most common comorbidities of chronic pain including, fatigue, depression, isolation, and others. (3565) Psychology and Integrative Medicine Collaborating to Treat Pediatric Chronic Pain Melanie Brown, MD1, Ashley N Junghans-Rutelonis, PhD1 1Children’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota Abstract Overview: Integrated behavioral health care offers exciting opportunities for medical and mental health professionals to work in collaboration to provide problem-focused treatment. The purpose of this workshop is to help integrative medicine providers (1) determine when to assess for chronic pain and concurrent psychological difficulties that would warrant referral to a mental health provider, (2) use brief assessment measures for chronic pain, and (3) practice interventions to target central nervous system centralization. Participants will increase their knowledge of and skills in focused treatments for chronic pain and will engage in hands-on activities for treating pediatric chronic pain within a medical setting. Rationale: Pediatric pain can be acute, disease related, chronic (eg, headaches or abdominal that has been present for more than 3–6 months), pain that is the disorder itself (eg, complex regional pain syndrome) or a combination of complex diagnoses. Estimated rates of pediatric chronic pain vary widely, with 5% of youth reporting moderate to severe pain and a much wider range depending on the pain severity, location, and frequency (4% to 88% [intermittent headache]; see review article by King et al.). Pediatric chronic pain has a significant negative impact on patient and family life and can lead to additional health, academic, sleep, social, physical, and functional difficulties lasting into adulthood. Recent research has shown the significant impact of integrative medicine and psychological therapies on the course, intensity, and duration of chronic pain. Given there are few providers who specialize in treating pain, it is important for integrative medicine providers to be able to identify risk factors for developing chronic pain and know how to intervene early and effectively. It is also critical for psychologists and integrative medicine specialists to work in collaboration to treat the mental and physical needs of youth with chronic pain. Patients and families strongly benefit from these 2 disciplines coordinating care to better understand diagnoses and treatment options, including appropriateness of inclusion of a psychologist for treating chronic pain. Objectives: This workshop will introduce participants to the concepts of integrated behavioral health care, chronic pain-focused treatment, and collaboration of pediatric psychologists in your medical practice. It will include 3 didactic modules: (1) determine when to assess for chronic pain and concurrent psychological difficulties that would warrant referral to a mental health provider, (2) use brief assessment measures for chronic pain, and (3) practice interventions to target central nervous system centralization. Outline: Integrated behavioral health care offers exciting opportunities for medical and mental health professionals to work in collaboration to provide problem-focused treatment. The purpose of this workshop is to help integrative medicine providers (1) determine when to assess for chronic pain and concurrent psychological difficulties that would warrant referral to a mental health provider, (2) use brief assessment measures for chronic pain, and (3) practice interventions to target central nervous system centralization. Participants will increase their knowledge of and skills in focused treatments for chronic pain and will engage in hands-on activities for treating pediatric chronic pain within a medical setting. (3579) A Hands-on Approach to Qualitative Methodology Using NVivo Eden Robles, PhD1, Juliana Cardoso Smith, MA1 and Rubi Gonzales, BA1 1University of Texas at El Paso, El Paso, Texas Abstract Overview: In this workshop, we will be providing a brief introduction of qualitative methodology and its major contributions to medicine and health research. The workshop will consist primarily of building analytic skills in qualitative research using the NVivo software. Helpful suggestions about the use of NVivo and resources will be provided. Attendees will be strongly encouraged to conduct a qualitative analysis with the assistance of panel members. Rationale: Given the contemporary focus on the need for culturally adaptive interventions and treatment in the health field, it is important for medical professionals to understand qualitative methodology. This workshop will be given as an introduction to health professionals who are interested in understanding qualitative research. Professionals who are interested in building their statistical skills can benefit from this workshop. Furthermore, being proficient in quantitative and qualitative methodologies will be be beneficial for professionals interested in conducting mixed methods research. More importantly, this workshop aims to merge the fields of social sciences and medicine. The panelists will demonstrate that other fields can utilize a qualitative approach to better understand their respective patients, participants, barriers for treatment access and utilization. Objectives: Attendees will also learn the basic and fundamental essentials of qualitative research and be able to successfully conduct a qualitative analysis using NVivo. In addition, attendees will also know about the resources available for NVivo users. Outline: Rubi: Intro to qualitative  • What is qualitative?  • How it differs from quantitative?  ○ Philosophical assumption  ○ Theoretical lens  • Benefits of qualitative  ○ Previous clinical/ medicine  ○ Opening doors to mixed methods designs  • Qual in health research—major publications? Juliana: NVivo analysis  • What is NVivo?  • Basics 101  • Helpful strategies  ○ Familiarize with data  ○ Develop themes  ○ code  • Dr Robles (Juliana and Rubi assisting) hands-on approach  • Trial download—attendees downloads software  • Dyad approach—2 people working together  • 3 small transcripts  • Analysis  • Interpreting data All panel members  • Answering questions  • Providing resources available  ○ NVivo website—community forum and support forum (3588) A Collaborative Model for Delivering Acupuncture Services as Part of Oncology Supportive Care in a Community Cancer Center—A Clinical and Educational Partnership Alexandra York, MS, CHWC1, Patsy L Astarita, LCSW, OSW-C2 1Maryland University of Integrative Health, Laurel, Maryland 2Upper Chesapeake Health, Bel Air, Maryland Abstract Overview: In 2015, the Maryland University of Integrative Health (MUIH) and the University of Maryland, Upper Chesapeake Medical Center, Kaufman Cancer Center (KCC) entered into a partnership to deliver an integrative medicine model in a community cancer center. Through the vision of a shared board member, who recognized alignment in mission and values, an opportunity to meet mutual needs was identified. The KCC was looking to grow their integrative medicine program and MUIH was seeking integrative clinical experiences for their doctoral acupuncture students. This proposed symposia will tell the story of this partnership utilizing a marriage metaphor (courting, engagement, marriage, marriage counseling, recommitment, flourishing and growth) in which we share the processes for establishing a partnership, program development, teaching clinic development, implementation, challenges and opportunities, lessons learned, and future work. More specifically, this symposia will highlight how KCC and MUIH’s mutual engagement has transformed each organization at many levels. Additionally, this symposia will engage attendees in creative thinking about the available resources in their settings and community which could be utilized to deliver integrative care in such partnership. The presenters will provide a scenario and invite the attendees to breakout into groups to think through all the aspects of implementing an integrative medicine model. Rationale: This innovative model is taking place in a community-based setting where the majority of patients receive cancer care. A large academic teaching institution or major cancer center is not required to enhance cancer treatment and deliver an integrative medicine model. This model spotlights true collaboration and integrative care. In doing so, the following needs are met for the institutions involved. For KCC, an opportunity to provide enhanced, supportive care service to cancer patients and their caregivers; to provide additional tools for symptom management readily available to cancer patients; and to provide acupuncture safely with the approval of a treating physician being mindful of the special needs of this at-risk population. For MUIH, to provide a rich learning environment where doctoral students are learning about oncology treatments, how to modify their treatment plans, and developing an understanding of the operations of a traditional medical setting; preparing students for communicating and collaborating with conventional, medical providers; through the experiences and lessons learned at the KCC Clinic, MUIH is enhancing the delivery of care at their Natural Care Center (student-based clinic at the University) through continuous improvement and additonal rigor. This symposia will demonstrate the exact theme of this conference—collaboration in action. Both MUIH and KCC have advanced their clinical practices, and MUIH has enhanced its educational programming through this collaboration. Objectives: Participants will gain knowledge and tools for how to implement a similar model or strategy to delivery care in their own community through collaborative partnership, understand important factors which should be considered in collaborative partnership while trying to create a customized model of integrative care in their personal settings and communities, learn about barriers and challenges which may be encountered through this process, and receive a call to action to consider developing a model that may work for them and begin to think about how to apply all of the above. Outline: Using marriage as a metaphor, each phase of the development and implementation process of the integrative model will be presented along with an overview of the structure and function of the student-based acupuncture clinic. The following the questions and topics will be address: • Why this was brought to our institutions? • How was it started? • Who were the stakeholders with this project? • What were the challenges/stumbling blocks you encountered? • Were there any financial issues/stumbling blocks? • What did we learn? • How was time managed? • Allocation of time between institutions—did one do more work? • Sharing of resources and tools that have come out of the process • Communication considerations • Program evaluation • Future considerations (3624) Pranayama: An Experiential Workshop on the Clinical Application of Yoga Therapy Breathing Practices at a Veteran’s Administration Mental Health Residential Treatment Program Anita Claney, MS1 1Tucson, Arizona Abstract Overview: Participants will learn basic yoga therapy breathing techniques, the objectives and goals of yoga therapy’s clinical application of breathing practices with regard to mental health care, specifically post-traumatic stress disorder (PTSD) and substance use disorder (SUD), and be taught and learn to teach an introductory breathing practice to clients. Rationale: From VA Solicitation: VA258-17-Q-0385: “There is continued evidence of how complementary and alternative treatments for post-traumatic stress disorder (PTSD) and substance use disorder (SUD) aid in the treatment for veterans in the Mental Health Rehabilitation Residential Treatment Program (MHRRTP). Specifically, in the PTSD track, data suggest significant difference from cohorts that received little to no yoga therapy compared to those that received yoga therapy twice or more per week. The cohorts that received yoga therapy twice per week reported significantly less anxiety and significantly less depressive symptoms. Over 6 years of clinical development and refinement by a yoga therapist, breathing practices were implemented as the primary yoga therapy treatment protocol in a residential mental health VA program. These practices aided in the regulation of affect and mood over the short and long term and were validated clinically as an efficacious component of an integrative approach to mental health care. Objectives: General understanding of yoga therapy breathing techniques; objectives and goals of yoga therapy’s clinical application of breathing practices with regard to mental health care, specifically PTSD and SUD; the complement between neurophysiology and yogic breathing practices with regard to autonomic nervous system function and regulation; and being taught and learning to teach an introductory breathing practice. Outline: 1. Introduction to Pranayama: Breathing techniques 2. Autonomic nervous system function and regulation and relationship to yogic breathing techniques 3. Clinical objectives and goals with regard to PTSD and SUD 4. Participants learning-basic techniques of breathing, sequencing, and how to teach a simple breathing practice (3647) Yoga Therapy: Special Implications for Working With the Neurological Population Anneke Bender, PT, MSCS, RYT200, Lauren Tudor, RT, RYT 2001, Marlysa Sullivan, PT, C-IAYT2 and Kelli Bethel, PT, C-IAYT, E-RYT 5003 1Sheppard Center, Atlanta, Georgia 2Maryland Univeristy of Integrative Health, Laurel, Maryland 3Baltimore, Maryland Abstract Overview: Yoga therapy, a growing complementary and integrative health profession, has gained rising attention as a method of treatment with special relevance for the neurologically impaired population. Demonstrated benefits highlight improved physical function, including increased strength, balance and peak expiratory flow, decreased fatigue, decreased pain, and decreased incontinence. Additionally, yoga has been demonstrated to positively impact mood, psychosocial function, and executive functioning for this group. Yoga is not merely a physical activity, nor is it wholly a meditative/mental practice, and it is the intersection of these aspects which is the intended point of focus. As such, yoga has unique significance and applicability for those with neurological illness or injury in that it precisely targets a neuroplastic response. In a systematic review of studies exploring Hatha Yoga and executive function, researchers theorized, “ … increases in mindfulness may improve focus on presented tasks while minimizing internal distractibility. Furthermore, the absolute concentration required to balance and coordinate movement through challenging, unfamiliar postures while synchronizing breath patterns may also facilitate attentional enhancement.” This quality is of distinct importance in a system whose sensory and motor responses are diminished and more difficult to perceive. This presentation will discuss the evidence behind the use of yoga for individuals with neurological conditions and will consider the integration of yogic concepts and techniques into neurological rehabilitation using an evidence-based approach. Rehabilitation professionals will describe the development of yoga programs across the continuum of care: during inpatient rehabilitation for TBI; as a community-based class outside of a hospital/medical setting for individuals with ABI; as part of a comprehensive MS Wellness Program; and working with the dementia population in both research and clinical contexts. Special considerations for each populations will be highlighted including adaptations in yoga therapy practice both relevant and directed to the needs of that population. Rationale: This presentation will discuss the unique role of yoga therapy in neurologic rehabilitation. Objectives: The aim is to describe aspects of a yoga therapy that have relevance to neurological rehabilitation and to the facilitation of a neuroplastic response, discuss current available evidence for the use of yoga in neurological rehabilitation and identify clinical questions yet to be addressed in the literature, describe the explanatory framework of yoga therapy including potential mechanisms for the neurological population, discuss modifications and variations of yoga therapy practices relevant to the needs of each population, and identify a process for evidence-based integration of yogic techniques into existing medical models across the continuum of care. Outline: • Overview of yoga and yoga therapy (Marlysa Sullivan) • Yoga for dementia (Marlysa Sullivan) • Yoga as a community-based wellness program (Anneke Bender) • Yoga for stroke survivors (Kelli Bethel) • Yoga for traumatic brain injury across the continuum of care (Lauren Tudor) (3667) Integrating Ayurveda for Management of Chronic Diseases: Guidance for Clinical Practice Ram Manohar, BAMS, MD1, Anupama Kizhakkeveettil, BAMS, MAOM, PhD2 and Sivarama P Vinjamury, MD, MAOM, MPH2 1Amritha Ayurvedic College, Amritapuri, Kerala, India 2Southern California University of Health Sciences, Whittier, California Abstract Overview: In 2015, 70% of global deaths were attributed to noncommunicable diseases (NCDs). Cardiovascular disease, cancer, diabetes, and chronic lung disease account for more than half of deaths caused by NCDs worldwide. These disorders are of long duration and generally progress slowly, leading to reduced quality of life in the affected population, adverse effects of treatments, and huge expenditures. However, through utilization of preventive measures, the prevalence of NCD can be significantly reduced. Ayurveda (literally The Knowledge of Life) is an approach to health care that offers personalised life style and nutritional counseling for prevention as well as management of chronic illness. Ayurveda offers a multimodal approach to the treatment of these diseases with herbal supplements and therapies (including biocleansing and rejuvenation) coupled with yoga to restore the harmony of the body, mind, and self. Ayurveda can complement, supplement, and even provide alternatives in certain conditions to conventional management of NCD, thereby enhancing the quality of life, achieving progression free survival, or reversal of disease. In this educational workshop, the theoretical approaches and practical applications utilized in the management of selected NCDs will be discussed. Attendees will learn about Ayurvedic diet, lifestyle modification, yoga, herbs, spices, biocleansing practices, and therapies for the management of NCDs. Rationale: During our discussions, we will highlight the specific clinical contexts for integrating Ayurvedic treatments in the management of selected NCDs. The benefits, risks, and expected outcomes will be highlighted. Since the potential of Ayurveda in contributing to integrative medicine is not yet widely recognized, our session will provide new insights for the development of integrative medicine, which is the major focus of International Congress on Integrative Medicine and Health 2018. Objectives: Participants will learn the principles of Ayurvedic medicine; role of Ayurvedic medicine in preventative care of chronic diseases; role of Ayurvedic medicine in management of chronic NCDs; and theoretical approaches and practical applications for management of selected chronic NCDs. Outline: • Introduction to Ayurveda • Basic Principles of Ayurveda • Preventative Care in Ayurveda • Ayurvedic Approach for diagnosis and management of chronic diseases • Explain Ayurvedic assessment of selected chronic diseases • Treatment principles for the selected chronic diseases • Diet and lifestyle for the selected chronic diseases • Herbal supplements for the selected chronic diseases • Therapies for the selected chronic diseases • Yoga for the selected chronic diseases • How the multimodal Ayurvedic interventions can be integrated effectively for management of the selected noncommunicable chronic diseases. (3670) Evaluation of an Integrative Teacher Wellness Program in a Baltimore Public School: A Mixed Methods Study Patrick McArdle, PhD1, Nate Costa, MS2, Chris D'Adamo, PhD1, Deborah Gioia, PhD1, Ariel Trilling, BS3 and Brian M Berman, MD3 1Baltimore, Maryland 2FX Studios and FX Well, Baltimore, Maryland 3University of Maryland School of Medicine, Baltimore, Maryland Abstract Overview: Two-year study of teacher wellness at an urban elementary/middle school, a partnership between Under Armour/FX Wellness and University of Maryland. Teachers received state of the art gym with trainers. Data collected: (1) validated measures from Patient-Reported Outcomes Measurement Information System; (2) qualitative semistructured interviews; (3) wearable fitness data; and (4) school-level administrative data. Self-reported improvements in health and health behaviors were reported. Rationale: Study fills a gap in understanding a health intervention designed to influence health and health-related outcomes and matches the conference theme on collaboration in action because of stakeholders: teachers, university researchers, and a fitness enterprise. Objectives: Participants will learn about project design, engaging external partners, measurement strategies, results, and future direction. Outline: 1) Description of a health and wellness intervention 2) Interprofessional project considerations 3) Measures used 4) Onsite data collection 5) Results of the study 6) Next steps (3671) Implementation of Hospital-based Infant Massage Program for Parents Elizabeth A Cross, PT, DPT, MSW, CLT1 and Lydia D Rawlins, MEd, OTR/L1 1Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Abstract Overview: Massage is a therapeutic technique that benefits both infants and parents in the home and medical settings. It relaxes and minimizes stress and relieves stomach discomfort from constipation, gas, and colic. It normalizes muscle tone, helps circulation, and promotes infant sleep. A more restful sleep stimulates brain development and enhances sensory awareness. Additionally, the caregiver/infant bond is strengthened through this nurturing connection. When parents are able to interpret the messages that their infant conveys through behavioral cues and body language they become more aware of their infant’s needs and are better able to respond in a more timely manner. Through a hands-on experience, presentation, and written didactic, attendees will learn how to implement a hospital-based parent and infant massage program for clients inpatient and outpatient setting. Rationale: The Neonatal Intensive Care Unit (NICU) is a very complex and highly specialized hospital environment designed to care for infant who are born prematurely or critically ill. Current research suggests it is this same environment that may have adverse impact on infant development particularly in 3 areas. These areas are premature exposure to light, prolonged exposure to loud noise, and adverse touch experiences. The NICU environment has made successful efforts to reduce light and noise exposure to infants in their milieu however adverse touch experiences continues to be a challenge. Existing literature indicates premature infants are most likely to be exposed to the greatest number of painful stimuli in the hospital setting. Overall, 77% of the pediatric population experience moderate to severe pain during their hospitalization. Research also indicates that parents are often excluded from the infants care due to their medically instability. This influences the infant’s exposure to positive touch experiences, their ability to bond with their caregiver, and subsequently impacts the development of infants. This influence transcends the hospital experience to home. Current research indicates that massage relaxes infants, minimizes stress, relieves stomach discomfort from constipation and gas, reduces pain, encourages normalization of muscle tone, and helps circulation. This supports infants’ sleep. A more restful sleep stimulates brain development and enhances sensory awareness. Additionally, the caregiver/infant bond is strengthened through this nurturing connection. While massage is a therapeutic technique that benefits both infants and parents in the medical and home settings, the challenge to integrate it as a standard of care in the hospital setting remains difficult. Objectives: At the end of the course, attendees will learn the benefits and contraindication of massage, name materials required and environmental considerations before initiating massage program in a hospital setting, participate in massage experience, and receive suggestions for implementation of infant massage program for inpatients and outpatients. Outline: Introduction to hospital-based massage program  a. Review power point  b. Provide guideline for implementation  c. Provide background skills for required implementation of program Review curriculum design and developmental progress  a. Review of how to obtaining client participation  b. Suggested frequency of program  c. Designing sessions: Massage technique and review of developmental skill Massage group experience  a. Simulation of massage training (2 techniques reviewed and 1 developmental skill such as “Tummy Time” Discussion and questions on infant massage in hospital setting  a. Review challenges to implementation of program  b. Suggestions for improving program obtained by participants from hosptial and community settings (offer resources)  c. Entertain questions (3847) Analysis of State Insurance Coverage for Nonpharmacologic Treatment of Low Back Pain as Recommended by the American College of Physicians Guidelines Robert A Bonakdar, MD, FAAFP, FACN1, Meg Sweeney, BS2, 3 and Dania Palanker, JD, MPP4 1La Jolla, California 2Western University of Health Sciences 3The College of Osteopathic Medicine, Pomona, California 4Washington, DC Abstract Overview: This session will report findings of a recent analysis of state insurance coverage for nonpharmacologic treatment of low back pain (LBP) as recommended by the American College of Physicians (ACP) Guidelines. The results will be used for a broader discussion of how nonpharmacologic approaches are viewed from an evidence-based and coverage standpoint as well as what clinicians and policy stakeholders can do to optimize coverage. Rationale: In February 2017, The ACP released guidelines for non-pharmacologic treatment of chronic LBP. These guidelines recommended utilization of treatments including multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (MBSR), tai chi, yoga, progressive relaxation, biofeedback, cognitive behavioral therapy (CBT), and spinal manipulation. These recommendations are one of the several recent recommendations calling for increased use of nonpharmacological approaches to pain. It is unclear how closely insurance parallels coverage for these evidence-based therapies. Thus, it is important to understand the level of coverage, rationale for noncoverage, as well as approaches for optimizing coverage when clinicians are faced with these recommendations. Objectives: The aim is to learn about Essential Health Benefits (EHB) Benchmark Plans for each state which represent the minimum benefits required in all new plans in the individual and small group health insurance markets; learn their state’s coverage for nonpharmacological treatments recommended by ACP guidelines; review how insurances statements view chronic pain, physical, and mental health benefits and decide on the evidence for various nonphamacological treatments; and understand current barriers to insurance coverage as well as clinician-, policy-, and system-level options for expanding coverage. Outline: • Other than spinal manipulation, evidence-based therapies recommended by the 2017 ACP guidelines were routinely excluded from state benchmark plans. • Insurance coverage statements routinely viewed pain in terms of acute or palliative care with little mention of chronic pain treatment in a comprehensive manner. • Current insurance coverage is outdated and seems largely arbitrary in terms of coverage for evidence-based nonpharmacologic treatments. • Coverage statements would benefit from clarity and expansion in the areas of behavioral care beyond mental health disorders as well as multidisciplinary, integrative care options for chronic pain care. • Clinicians, students, administrators, and policy experts should be increasingly aware of the disparity between recommendation and coverage in order to promote evidence-based coverage and understand models for provide recommended care. Note: the full abstract of the research that will be utilized as a point of discussion is listed below. Analysis of State Insurance Coverage for Nonpharmacologic Treatment of Low Back Pain as Recommended by the American College of Physicians Guidelines Background: In February 2017, The American College of Physicians (ACP) released guidelines for nonpharmacologic treatment of chronic low back pain (LBP). These guidelines recommended utilization of treatments including multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (MBSR), tai chi, yoga, progressive relaxation, biofeedback, cognitive behavioral therapy (CBT), and spinal manipulation. We aimed to determine state insurance coverage for these treatments. Methods: The 2017 state Essential Health Benefits (EHB) Benchmark Plans, which represent the minimum benefits required in all new plans in the individual and small group health insurance markets, were reviewed for coverage related to practitioner-based treatments recommended by ACP guidelines. Additionally, modality and insurance specific publications related to EHB were reviewed for comparison. Results: Nearly all coverage statements did not specifically address chronic pain. Modality coverage was highest for spinal manipulation with coverage in 46 states. Multidisciplinary rehabilitation as an entity beyond physical therapy could not be evaluated in nearly all state coverage statements. Similarly, CBT coverage for LBP could not be determined in most cases as although behavioral health coverage was noted, it was restricted in many cases to mental health diagnoses. Acupuncture, massage, and biofeedback were covered by 5 states or less with MBSR, tai chi, yoga, and relaxation therapy not officially covered by any states. Conclusion: Other than spinal manipulation, evidence-based therapies recommended by the 2017 ACP guidelines were routinely excluded from state benchmark plans. Insurance coverage statements routinely viewed pain in terms of acute or palliative care with little mention of chronic pain treatment in a comprehensive manner. Current insurance coverage is outdated and seems largely arbitrary in terms of coverage for evidence-based nonpharmacologic treatments. Coverage statements would benefit from clarity and expansion in the areas of behavioral care beyond mental health disorders as well as multidisciplinary, integrative care options for chronic pain care. (3855) Heart of Caring Yoga Nursing Damaris m Grossmann, RN DNPc1 1Rutherford, New Jersey Abstract Overview: The purpose of this activity is to enable nurses to utilize yoga nursing to reduce stress, burnout and musculoskeletal problems for themselves and patients through the utilization of diaphragmatic breathing, gentle stretching, and relaxation techniques. Yoga nursing program content is holistically orientated. addressing mind, body, spirit, and emotion. Yoga nursing includes centering as well as spiritual learning sutras. Multiple aspects of learner perception: multiple senses during educational experience including deep breathing, movement, and deep relaxation. Rationale: Health-care professionals are stressed, burned-out, have many musculoskeletal problems. The desired outcome acquires knowledge and skills to help reduce stress, burnout, and musculoskeletal problems; improves well-being for self and patients; teaches individual stress management; improves the immune system and overall health, resulting in decreased absenteeism and sickness levels, decreases headaches; increases productivity, motivation, and work performance; improves decision-making and creativity; increases energy, mental alertness, and clarity; improves morale, job satisfaction, and positive thinking patterns; reduces muscle tension and pain due to sedentary working positions; improves flexibility and physical strength; creates team building through relaxation; and yoga nursing remedies can be shared with patients—will increase patient satisfaction outcomes. Objectives: The aim is to describe yoga nursing; explain the beneficial components of yoga nursing; explore the technique and benefits of sacred breath; demonstrate the 7 essential therapeutic yoga postures of sacred movement and describe ideas for incorporating postures into self-care and individual clinical practice; describe beneficial components of sacred rest; and summarize the therapeutic benefits of yoga as an adjunct therapy in nursing practice and in a variety of clinical settings. Question and answer. Outline: 1. Yoga nursing  a. Definition: The union of ancient yoga with modern nursing, new accredited therapy, treatment for stress, anxiety, pain, suffering (SAPS).  b. Mission: To build an army of modern Nightingales, enlighten health care, relieve SAPS in nurses and all they serve.  c. Yoga nursing sutras  d. SAPS 2. Sacred remedy  a. Sacred breath  b. Sacred movement  c. Sacred rest 3. ABC’s of yoga nursing  a. Awareness  b. Breathing  c. Circulation 4. Benefits of yoga nursing  a. Nursing self-care  b. Patients, hospitals, other organizations 1. Sacred breath  a. Science of breath  b. Components of 3 part breath  c. Examples of evidence-based practice utilizing breathing techniques  d. Physiological and psychosocial changes as a result of yoga breathing techniques  e. Practice sequence of 3 part breath 1. Sacred movement  a. Seven postures: Mountain, Half Moon, Cobra, Forward Bend, Wind Relieving Series, Knee Down Twist, Relaxation Posture  b. Adaptations and modifications required for self and clients with different disabilities and conditions  c. Ideas for incorporating postures:  i. Self-care during breaks at work  ii. Patients who are bedridden  iii. Other patient populations 1. Sacred rest  a. Basic concepts and components of yoga nidra and meditation techniques.  b. Evidence of efficacy of yoga nidra and meditation in clinical practice.  c. Benefits for different patient populations  i. Post traumatic stress  ii. Heart, stroke, and cancer patients  iii. General population suffering from psychological, emotional, and physical painiv. Care giver burnout  d. Practice one guided relaxation technique: the practice of Yoga Nidra 1. Evidence-based benefits list 2. Clinical settings  i. Hospitals  ii. Corporations  iii. Oncology clinics 3. Use as a component of practice for nursing excellence (3876) Tibetan Yoga: Simple Breath and Movement Meditative Techniques for Everyday Life Alejandro Chaoul, PhD1 1Houston, Texas Abstract Overview: The Tibetan Yoga program that will be taught during this workshop is based on ancient texts and teachings from the Tibetan Bon Buddhist tradition as taught by Tenzin Wangyal Rinpoche. Parts of this practice have been used at MD Anderson dating back to 1999. Since then, we have utilized these particular Tibetan Yoga techniques that include breath and movement in randomized clinical trials for people with lymphoma, and women with breast cancer, as well as a single-arm trial for people with lung cancer and their caregiver. Findings from these studies have been published in Cancer and PsychoOncology journals. These are also part of our free group class offerings for people touched with cancer (patients and caregivers) in our Integrative Medicine Center. These practices have been adapted to remove any religious aspects. People from any religious or nonreligious background can use them to help reduce distress and improve mental function and overall well-being. We have also used them in our meditation group for Faculty Health and Wellbeing at MD Anderson and The University of Texas McGovern Medical School in Houston. Rationale: Tibetan Yoga is not as well-known as Indian yogas but not only they are an ancient mind–body practice which has been continuously practiced for centuries without interrumption in Asia, but since 1999 we have included them in reseach and clinic at MD Anderson Cancer Center’s Integrative Medicine Program, with good outcomes for patients and caregivers. To create this program, there was collaboration of Tibetan Lamas (teachers) together with Western researchers, to bring an authentic mind–body practice adapted for the contemporary western mind, and in particular people with cancer. In that way, we are advancing integrative health through research, education, and into the clinic. Objectives: The goal of this workshop is to provide the participants with meditative techniques that can help them release tensions and cultivate a more relaxed, peaceful yet aware state of mind even in the midst of life obstacles (eg, stress from work or other, fatigue, lack of sleep). In this way, one can also cope with negative emotions such as anxiety, or anger, and learn the ability to objectively and nonjudgmentally acknowledge those unwanted circumstances or feelings and release them, returning to a meditative state of mind that provides more choices than the flight-fight response. This also supports cultivating the positive qualities (ie, love, joy, compassion, and equanimity) inherent in all human beings. Outline: • Historical introduction to the concepts and techniques • Importance of intention • Applications in cancer care settings • Breathing, awareness, and concentration • Tibetan Yoga Movements • Conclusion with sharing the benefits with others (3879) Inspiring the Next Generation of Integrative Medicine Rebekah Wilks1 and Marisa Soski2 1University of Western States, Portland, Oregon 2National University of Natural Medicine, Portland, Oregon Abstract Overview: This interactive workshop will provide the tools necessary to assist faculty and students in constructing Integrative Medicine organizations at their respective institutions. Rationale: The 2007 National Health Interview Survey conducted by the U.S. Centers for Disease Control and Prevention (CDC) released that 38% of Americans (114 million) used alternative forms of health care. It is postulated that $7.7 billion are wasted by patients who utilize both forms of health care but do not inform either their complementary or conventional provider. This simultaneously increases healing time, the probability of interactions, and cost; this is not reflective of patient-centered care. It has become increasingly paramount to educate health-care professionals on the importance of interprofessional communication and collaboration, especially when these practitioners are students. The Student Alliance for Integrative Medicine (SAIM) in Portland, Oregon, is working to teach budding professionals the importance and value of Integrative Medicine. SAIM is a unique organization comprised students from various health-care disciplines, including Chinese Medicine, Chiropractic Medicine, Naturopathic Medicine, Occupational Therapy, Pharmacy, Psychology, and Traditional Medicine. We were developed to address the necessity for engaging medically focused students in integrative medicine before they enter the workforce, so that they will be equipped with interprofessional networking skills, knowledge of treatment modality effectiveness, and a general respect for colleagues and other professions. SAIM has been assembling a tool kit to be placed on our website that will help other students and institutions begin to implement their own organizations and integrative medicine networks. Ultimately, this workshop will help promote Integrative Medicine by facilitating and motivating students and professionals to build interprofessional relationships for purposes of attaining the goal of high-quality patient-centered care. Objectives: The aim is to outline the importance of involving students in Integrative Medicine; present the SAIM tool kit; and help participants develop concrete steps for creating their own organization. Outline: Importance of engaging students in Integrative Medicine Tool kit components: with fill-in-the-blank handout and hands-on components throughout, illustrating from website and engaging the audience with a Moodleroom cafe 1. Identify key players at their institutions  • Find a faculty/staff mentor 2. Identify protocols for establishing a new organization at their institution 3. Identify institutions in the area to collaborate with 4. Form an organizational structure  • Develop and implement a charter  • Fill officer positions  • Ensure continuity 5. Build a following/promotion/marketing on campus and in their communities  • Website/social media  ○ Timing  ○ Which platforms work best  ○ Website structure  • Fund-raising 6. Event ideas  • Students/faculty/staff  ○ Social/networking events  ○ Educational events  • Interactive  • Speaking engagements  • Community  ○ Integrative Medicine Day  ○ Integrative Medicine Grand Rounds Small presentations within breakout groups followed by constructive feedback session 1. Brainstorm components in small groups  • Optional, time permitting: present small group discussion to the larger group Question and answer (3895) Is Agni-the Ayurvedic Gut Microbiome? Principles and Practical Implications for Integrative Health-care Practitioners Anupama Kizhakkeveettil, BAMS, MAOM, PhD1, Sivarama Prasad Vinjamury, MD, MAOM, MPH1, Jayagopal Parla, MD, MAOM1, Manjusha Vinjamury, MD, MAOM1 and Bharathi Venkat, BAMS1 1Southern California University of Health Sciences, Whittier, California Abstract Overview: Agni is defined as the “digestive/metabolic fire” in Ayurveda. Its central role in the disease pathogenesis parallels to the recent understanding of the function of the gut microbiome. Optimal function of agni is important for nutrition, immunity, and effects on the brain and behavior, similar to the gut microbiota. In this educational session, the theory and practical implications of agni will be discussed along with the pathogenesis and evidence-based ayurvedic treatments for irritable bowel syndrome, metabolic disorders, and depression. Additionally, ayurvedic herbs and formulas used as prebiotics and probiotics for maintaining and restoring the function of agni will be discussed. In the hands-on experiential component of this workshop, attendees will learn how to prepare simple ayurvedic herbal teas, organic ghee, juicing, yoga, and oil massages that can be easily adopted in integrative practices as supportive care as well as use these remedies for self-care. Rationale: The presentation will focus on describing, translating, explaining, and discussing ayurvedic concept of “agni” and communicate effectively with other health-care professionals to demonstrate its similarity with current knowledge of gut microbiome. The session’s focus will be to articulate its relevance and use from a biomedical perspective. The individual presentations will provide the relevance of agni and its evaluation in specific diseases such as irritable bowel syndrome, mental health, and so on, along with simple remedies that can be easily incorporated in integrative health-care practices. The experiential component will offer the conference attendees necessary skills to prepare certain recipes and teach DIY techniques to build agni, which they can pass it on to their patients. The significance of this session is its overall emphasis in 2 important areas: Integrative Health Care to improve patient outcomes as well as patient empowerment using evidence based information. Therefore, we believe that it matches the conference theme of advancing integrative medicine through education and clinical perspective. Objectives: Participants will be able to learn about ayurvedic concept of agni and its relevance, assess status of agni, if relevant in their practices, describe its usefulness in clinical practice, integrate some simple DIY home remedies in their practice, experience the taste of herbal teas and products, and describe the yoga postures and experience them as well. Outline: The session will start with 5 brief presentations: 1. Overview of agni—theory and practical application 2. Ayurvedic prebiotics and probiotics 3. Agni dysfunction in the etiopathogenesis of irritable bowel syndrome and metabolic disorders 4. Can agni imbalance in the gut cause an imbalance in psychological state (depression) of a person? 5. Quick overview of agni and gut microbiome—similarities and differences. How can you integrate it from tomorrow in clinical practice? These presentations will be followed with an experiential session where in the participants will touch, feel, smell the ayurvedic prebiotics and probiotics. This session will also include the demonstration of preparation of herbal teas, ghee, and oil applications. Finally, the attendees will experience yoga postures and breathing techniques that focus on agni nourishment. (3918) Approaches to Integrative Health and Mind–Body Strategies for Persons With Hypermobility-related Disorders, such as Ehlers–Danlos Syndromes, Hypermobility Spectrum Disorders, and Comorbid Conditions: A Movement and Mindfulness-based Health Education Program Kendra Neilsen Myles, BS1 1EDS Wellness, Inc., Bethesda, Maryland Abstract Overview: Kendra Neilsen Myles, Certified Health Education Specialist (CHES), RYT 200, founder of EDS Wellness, Inc. a Maryland-based 501(c)(3) nonprofit, joined forces with Dr Clair Francomano, director of The Harvey Institute for Human Genetics at Greater Baltimore Medical Center (GMBC), to establish evidence-based patient and health education resources on integrative health therapies and to develop and implement a mindfulness and movement-focused program for Individuals with hypermobility-related disorders such as Ehlers–Danlos syndromes (EDSs), hypermobility spectrum disorders (HSDs), and comorbid conditions. Combined with educational materials on integrative health strategies, the ability to attend weekly gentle yoga classes with a knowledgeable instructor and the support of a monthly mind–body-centered group meeting, EDS/HSD patients are provided the opportunity to learn about and engage in diverse self-care and mind–body-focused activities to help manage chronic pain and other common symptoms associated with hypermobility-related disorders. These activities include learning how to practice yoga safely with hypermobility, engaging in several types of yoga practices, exploring various breathing and mindfulness exercises, cultivating the principles of natural movement and restorative exercise into daily life, and experiencing various types of meditation. Rationale: Through a collaborative agreement with Deborah Norris, PhD, founder of The Mindfulness Center in Bethesda, MD (also a Maryland-based 501(c)(3) nonprofit), and led by a CHES, who is also a 200-h certified yoga instructor, patients living with chronic pain and multisystemic conditions such as EDS and HSD explore their fears discover their strengths and face their weaknesses—all with a collective goal of increasing physical strength and stamina, regaining function, finding self-empowerment over the medical condition(s) they live with, and improving their general health status. This program culminates in a mind–body-focused exploration in discovering evidence-based integrative strategies for living well. Clinical significance: EDSs are the collection of disorders that affect the structure or function of collagen, the most abundant protein in the body. Since collagen is in nearly every type of connective tissue in our bodies, including our bones and blood, EDS often impacts each system in the body in some way. EDS is believed by some researchers and specialists to be the “most neglected disorder(s) in modern medicine.” Previously believed to be “rare,” geneticists and providers who specialize in the diagnosis and management of patients with hypermobility-related disorders, such as EDS, believe that in reality, EDS is “rarely diagnosed.” In the persistent quest to validate and understand the numerous chronic and multisystemic issues EDS patients face, EDS researchers and specialists collaborated on a major classification update to all types of EDSs and introduced the newly described HSDs—both groups of conditions fall under the broader hypermobility-related disorders umbrella. The newly updated EDS and HSD classification was published in The American Journal of Medical Genetics on March 15, 2017, and includes management and care guidelines that providers of all specialties can follow. However, despite the recent classification update or the increased awareness in some groups, most of the mainstream medical community still lacks understanding and knowledge on EDS, HSD, or other hypermobility-related disorders. Additionally, other multisystemic conditions that often found comorbidly with hypermobility syndromes, such as mast cell activation syndrome and dysautonomia/postural orthostatic tachycardia syndrome, are also poorly understood and overlooked. Patients are left lonely, often feeling hopeless, and scared of either mistreatment or injury in the hands of uneducated providers. They scramble, often alone, trying to pieces of their medical puzzle together and search for ways to stop their bodies from becoming unglued—literally. The result? All of us, patients, health-care providers, and caregivers are left with the reality that we are facing a true public health crisis—an epidemic of misdiagnosis after misdiagnosis, preventable medical mistakes, and life-threatening disability—even death. Patients need treatment options and hope. Most will never live to see a cure, and waiting for researchers to discover the gene responsible for hypermobile EDS, will not help us find ways to live well now. Hence, the rationale behind EDS Wellness’ mission and vision to help patients learn ways to regain function and live as well as possible now through research and the development of programs focused on integrative health. The same rationale applies to the development of this program and the submission of this abstract. We are facing a public health crisis and the “EDS Spiral” can be haulted through proper professional and medical education, the development and implementation of health education programs and research initiatives focusing on integrative health strategies—we need to help patients help themselves. Objectives: Based on Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction Program, patients employ the use of gentle movement and meditation as self-directed strategies for managing chronic pain and other symptoms often associated EDS, HSD, and other multisystemic conditions. Movement and mindfulness-based activities are used to help guide patients to uncover long-standing insecurities surrounding their health and explore their physical, mental, and emotional weaknesses in safe, supportive environment. Patients are challenged to hone lifelong lifestyle and behavior changes needed to regain confidence, a sense of personal control over their health care, and stability in their overall well-being. Outline: Over the past year, approximately 20 individuals have developed lifestyle and mind–body strategies for living well with EDS, HSD and related chronic conditions, evolved through slow and deliberate behavior changes, and learned through participation our program. Postimplementation program evaluation includes interactive group participation, weekly or monthly program, and attendance and completion of the postprogram evaluation and feedback survey. Individual gains are evident through increased physical strength and endurance, improved mental and emotional health, regular journaling, and a commitment to a consistent, self-directed movement and mindfulness-based at-home program. (3939) An Innovative Approach to Health Education: Blending “Informal and Formal” Curricula to Expand Ancestral, Integrative, and Functional Medicine Education Robert D Abbott, MD1, 2, Adam Sadowski, BS, ND(c)3, Guillermo Ruiz, ND4 and Zach Pope, BS, MD(c)5 1University of Virginia, Charlottesville, Virginia 2Virginia Commonwealth University, Shenandoah Valley, Front Royal, Virginia 3National University of Naturopathic Medicine, Portland, Oregon 4Southwest College of Naturopathic Medicine, Tempe, Arizona 5University of Tennessee College of Medicine, Memphis, Tennessee Abstract Overview: According to the World Health Organization, a health-care system involves “all the activities whose primary purpose is to promote, restore or maintain health” (The World Health Report 2000—Health systems: improving performance). This broad definition encompasses health-care practitioners, health-care students, and patients. In recent years, the ancestral, integrative, and functional medicine (FM) movements have helped empower all 3 of these groups. The Institute for Functional Medicine defines FM as a system that addresses the underlying causes of disease, using a systems-oriented approach, engaging both patient and practitioner in a therapeutic partnership. The University of Arizona defines Integrative Medicine (IM) as healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient is informed by evidence and makes use of all appropriate therapies. Ancestral Health can broadly be described as an approach to health focused on optimizing lifestyle habits involving diet, sleep, social interaction, movement, and spiritual engagement based on the evolutionary history of our ancestors as well as our more recent cultural relatives. An obstacle for all of these movements, however, is that the delivery of information and educational resources is limited as part of most formal medical education programs. Books, websites, videos, podcasts, and even online-based trainings can be easily found on the Internet but not easily organized or vetted for relevance and validity. As part of this panel discussion, we highlight the need to expand one’s ancestral, integrative, and functional medicine education beyond what is currently being offered through formal trainings or beyond what may be entirely absent from many medical schools and residency programs. The discussion will feature a family medicine resident, a medical student, a naturopathic medical doctor, and a naturopathic medical student each describing various ways to expand the “informal” integrative medicine curricula. Rationale: Health education and its delivery are changing. Medical school costs are exceeding $200 000 and the demand for integrative and functional clinicians well versed in lifestyle and root-cause resolution approaches to health is outpacing the current supply. Many medical schools and residency programs still provide very little nutrition, lifestyle, or integrative medicine education as part of their formal curricula. The majority of students are often unaware of ancestral, integrative, and functional approaches to wellness outside of their formal school training and are often easily overwhelmed by the breadth of knowledge required as part of their formal education. Collectively, practitioners need educated and empowered patients and patients need educated and open-minded clinicians. We are a worldwide community needing change in order to promote health and need each other to thrive. This panel discussion highlights the need to synthesize and broadcast some of the most relevant health education resources currently available including both freely available, informal educational resources, and formal integrative medicine training programs so students and clinicians can expand/complement their formal traditional medical training with a robust and comprehensive exposure to ancestral, integrative, and functional medicine. Objectives: Participants will be able to discuss the availability, utility, and accessibility of educational resources with regard to an ancestral, functional, and integrative approach to health; to provide a methodical and practical approach for exploring educational resources with regard to identified goals, intentions, and cognitive/learning styles; to allow one to appreciate the need for broadening one’s approach and understanding of currently available educational resources including both those that are freely accessible and those available through formal trainings/certification programs; to expand their “informal” integrative medicine education, utilizing a combination of resources available outside of their formal training or institution; to engage in a thoughtful discussion about the benefits and potential pitfalls of utilizing freely available resources; and to brainstorm creative ways to increase the number of “informed” students and clinicians with regard to ancestral, integrative, and functional medicine. The additional aims are as follows: For clinicians, to empower them to expand their education into integrative, ancestral, and functional medicine as well as to provide them with a framework to offer concise and individualized educational health resources/plans tailored to the individual interests, concerns, and preferred learning style of their patients; for students, to provide them with a practical, complementary education plan to support their current academic endeavors, tailoring the experience to their available financial resources and preferred cognitive learning style; for patients, to provide them and their families with reliable and relevant educational resources, to empower them to utilize a variety of resources to aid in lifestyle and habit change, and to allow them to appreciate the need for collaboration with an experienced holistic clinician when necessary. Outline: Definitions and introductions Define ancestral, integrative medicine, functional medicine Define health education Personal experiences Each presenter will describe their personal experience and exposure to ancestral, integrative, and functional medicine during their formal training and/or as part of their current training Main questions to address Are current certification and training programs focused on integrative health educating enough clinicians? What are the gaps in formal and informal education? How can students and clinicians discover and access resources outside of formalized curricula and remain evidenced based? How do we increase exposure to ancestral, integrative, and functional medicine to more students, residents, and clinicians in training? What are the current barriers to schools offering formal trainings and how can students access reliable resources if their institution has no such integrative medicine program? What are the potential downsides of pitfalls of relying entirely on freely accessible resources to provide the bulk of one’s integrative medicine education? What are the best short-term solutions to the long-term problem of creating more engaged integrative medicine practitioners? Discussion: Open audience discussion and question and answer for panel. Poster Research, Nonresearch Abstracts (1069) Philosophical Principles of Healing in Reference to the Yoga Sutras of Patanjali Ji Yashoda, PhD1 1Indian Board of Alternative Medicines, Berlin, Germany Abstract Purpose/Objective: The purpose of this qualitative study is to examine the role of Patanjali’s Yoga Sutras in supporting experiences of healing, holistic health, and wholeness in advanced Western yoga practitioners. Multiple studies have shown the potential positive health effects of yoga, yet little is known about the holistic health experiences of those individuals to whom the entirety of the practice and philosophy as laid out by Patanjali is accessible and who properly study and practice according to the Yoga Sutras. Results: Data analysis suggests that yoga practice in the form of studying Patanjali’s yoga philosophy and following its prescribed practice, results in subjective holistic health experiences, and furthers the experience of the transpersonal self. Conclusions: Expansion of consciousness promotes healing, health, and wholeness. Patanjali’s cosmic yoga philosophy aids in expanding participant’s consciousness into wholeness, thereby affirming classical yoga’s claim that in an ultimate sense healing is liberation (Kaivalya) from suffering and wrong identification (Avidya). (1073) Management of Primary Ovarian Insufficiency With Herbal Medicine and Acupuncture: 3 Case Reports Eun-Ji Choi, BD and Jae-An Shin, BD1 1Jayoon Oriental Medical Clinic, Gyeonggi-do, Republic of Korea Abstract Purpose: Primary ovarian insufficiency (POI) is the dysfunction of ovaries before age 40. There are conventional management options such as hormone therapy, psychosocial support, and routine health assessment. Recently, herbal medicine and acupuncture have also been used to support women’s health. The aim of this study was to describe the outcome of the herbal medicine and acupuncture treatments in 3 women with POI. Results: After the treatment, the follicle stimulating hormone (FSH) and estradiol levels of all patients were normalized, and they had periods of menstruation. The FSH levels dropped from 100.4 to 8.0 mIU/mL (case 1), 96.3 to 5.6 mIU/mL (case 2), and 73.9 to 5.2 mIU/mL (case 3). Estradiol levels increased from <10 to 230 pg/mL (case 1), 10 to 552 pg/mL (case 2), and <10 to 191 pg/mL (case 3). Case 1 and 2 had 2 periods, and case 3 had 4 periods during treatment. Conclusions: This study suggests that herbal medicine and acupuncture may be potential therapeutic options for women with POI. Further studies are needed to support the results. (1076) Preclinical Evaluation of a Mistletoe Extract (Viscum album) in Pediatric Tumor Cells Melanie Schwermer, PhD1, Katrin Menke2, Jürgen Eisenbraun, MD3, Alexander Schramm, PhD4, Alfred Längler, MD5 and Tycho Zuzak, MD6 1Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany 2University Children’s Hospital Essen, Essen, Germany 3ABNOBA GmbH, Pforzheim, Germany 4University Hospital Essen, University of Duisburg-Essen, Essen, Germany 5Gemeinschaftskrankenhaus Herdecke, University Witten/Herdecke, Herdecke, Witten, Germany 6Gemeinschaftskrankenhaus Herdecke, University Hospital Essen, Herdecke, Essen, Germany Abstract Purpose: In Europe, mistletoe preparations are one of the most frequently used complementary and alternative therapies in adults and children. Despite numerous preclinical and clinical studies, the efficiency and safety of mistletoe therapies remain controversial. In particular, studies validating the effectiveness in pediatric tumor entities are missing. Therefore, in this study, the anticancer effects of a mistletoe extract (abnobaVISCUM Fraxini) were investigated in pediatric tumor cell lines. Results: All tested pediatric cell lines were shown to be more sensitive to the dandelion extract treatment than normal human fibroblast cells. Our results revealed an induction of apoptosis upon mistletoe treatment. Elevated caspase-9 levels as well as a loss of mitochondrial integrity indicated a contribution of the intrinsic signaling pathway. In addition, inhibition of migration and invasion capacities was demonstrated after treatment. In in vivo experiments, the intraperitoneal injections of allotransplanted mice caused a reduction of tumor growth and prolonged overall survival rates. Conclusions: In conclusion, our study provides first preclinical data for the effectiveness of abnobaVISCUM Fraxini in pediatric tumor cells and stresses the need for qualitative clinical studies to validate our observations. (1077) Taraxacum Officinale Extract Induces Antitumorigenic Effects in Ovarian Carcinoma Cell Lines Tycho Zuzak, MD1, Katharina Falke, BSc2, Jennifer Felenda3, Christiane Beckmann, MD3, Florian Stintzing3, Anette Voigt, MD4, Katrin Menke2, Alexander Schramm, PhD5, Alfred Längler, MD6 and Melanie Schwermer, PhD4 1Gemeinschaftskrankenhaus Herdecke, University Hospital Essen, Herdecke, Essen, Germany 2University Children’s Hospital Essen, Essen, Germany 3WALA Heilmittel GmbH, Bad Boll/Eckwälden, Germany 4Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany 5University Hospital Essen, University of Duisburg-Essen, Essen, Germany 6Gemeinschaftskrankenhaus Herdecke, University Witten/Herdecke, Herdecke, Witten, Germany Abstract Purpose: Ovarian carcinoma is the most lethal of all gynecological cancers and the fifth most common deadly cancer disease among women worldwide. Despite intensive multimodal treatment options including surgery, chemotherapies, radiation, hormone therapy, and targeted therapies, the 5-year survival rate (46%) unfortunately stagnates in the last decades. This fact and also other reasons may be responsible for the increasing use of complementary and alternative medicine. In Europe, mistletoe therapy accounts to one of the most popular herbal preparation. For the treatment of ovarian cancer, it is often combined with dandelion (Taraxacum officinale) extracts. Thus, our study aims to shed light on the anticancer properties of a dandelion extract as single agent or in combination with mistletoe preparations in ovarian carcinoma cells. Results: It was shown that both ovarian carcinoma cell lines were susceptible to dandelion extract treatment within a panel of adult tumor cell lines. In addition, the dandelion preparation induced apoptosis and reduced mitochondrial integrity, indicating an involvement of the intrinsic apoptosis pathway. Our data also elicited an inhibition of migration upon dandelion treatment. Moreover, combinational treatment with mistletoe extracts revealed a synergistic antiproliferative effect on ovarian carcinoma cells. Conclusions: In conclusion, our results support the efficiency of combination therapy including mistletoe and dandelion extracts for the treatment of ovarian cancer patients in vitro. Nevertheless, efficiency and safety have to be elucidated in further in vivo studies and in clinical trials. (1078) Systematic Literature Search of Complementary Therapies for the Treatment of Acute Gastroenteritis in Children With a Focus on Anthroposophic Medicine Melanie Schwermer, PhD1, Alfred Längler, MD2, Tycho Zuzak, MD3, Katharina Fetz, MSc4 and Thomas Ostermann, PhD4 1Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany 2Gemeinschaftskrankenhaus Herdecke, University Witten/Herdecke, Herdecke, Witten, Germany 3Gemeinschaftskrankenhaus Herdecke, University Hospital Essen, Herdecke, Essen, Germany 4University Witten/Herdecke, Witten, Germany Abstract Purpose: Acute gastroenteritis in childhood accounts for about 10% of hospital admissions and is still one of the major causes of death worldwide. In hospitals and pediatric practices with an integrative orientation children suffering from acute gastroenteritis are often treated with complementary and alternative medicine (CAM) associated therapies. Therefore, a systematic literature search was conducted to present an overview of applied CAM therapies, especially anthroposophic therapies, indicated for acute gastroenteritis in children. Results: Here, articles for diverse CAM-associated therapies (eg, anthroposophic medicine, herbal preparation, dietary management) were identified. The majority of hits were reached for dietary therapy approaches (124). Articles considering anthroposophic approaches constitute only 3.11% (7) of all articles. Among these articles, 2 observational studies (WALA Gentiana comp., WALA Bolus alba comp.), 3 experience reports, and 2 reviews were identified. For the anthroposophic remedies used in these articles, a second systematic search was performed. This search revealed surveys for Chamomilla, Ipecacuanha, Podophyllum, and Tormentilla preparations (mostly homeopathic) indicated for the treatment of gastroenteritis or its symptoms in children. All surveys reported about successful treatment or even reduction of disease course. Conclusions: All in all studies concerning anthroposophic approaches and medications, respectively, are deficient. The results of this study underline that effort is needed to validate anthroposophic therapies in a clinical setting. (1079) A Systematic Literature Search: Anthroposophic Therapies in the Treatment of Pseudocroup in Childhood Thomas Ostermann, PhD1, Katharina Fetz, MSc1, Tycho Zuzak, MD2, Alfred Längler, MD3 and Melanie Schwermer, PhD4 1University Witten/Herdecke, Witten, Germany 2Gemeinschaftskrankenhaus Herdecke, University Hospital Essen, Herdecke, Essen, Germany 3Gemeinschaftskrankenhaus Herdecke, University Witten/Herdecke, Herdecke, Witten, Germany 4Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany Abstract Purpose: In Europe, only few integrative pediatric wards exist—and in Germany, 2 of them have a focus on anthroposophic medicine as part of complementary and alternative medicine (CAM). Whilst the most common pediatric diseases are treated here, pseudocroup patients make up a large group in these hospitals, receiving conventional as well as anthroposophic therapies. However, effectiveness of these therapy concepts mostly based on physician’s experiences, but clinical studies are hitherto missing. Results: One retrospective study and 5 experience reports describing anthroposophic treatments were found. Here, a broad spectrum of anthroposophic medications (eg, Aconitum, Apis, Bryonia, Hepar sulfuris, Lavender, Pyrit, Sambucus and Spongia) for the treatment of pseudocroup were described. Conclusions: Our study demonstrates that clinical trials investigating the scientific evidence for their effectiveness are sparse. Therefore, development and validation of therapy strategies are required. (1080) Rational and Effective Therapies for Children: Scientific Reappraisal of Integrative Therapy Concepts in Anthroposophic Pediatrics Melanie Schwermer, PhD Alfred Längler, MD2, Tycho Zuzak, MD3, Katharina Fetz, MSc4, Thomas Ostermann, PhD4, Jan Vagedes, MD5, Markus Krüger, MD6 and David Martin, MD4 1Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany 2Gemeinschaftskrankenhaus Herdecke, University Witten/Herdecke, Herdecke, Witten, Germany 3Gemeinschaftskrankenhaus Herdecke, University Hospital Essen, Herdecke, Essen, Germany 4University Witten/Herdecke, Witten, Germany 5ARCIM Academic Research in Complementary and Integrative Medicine, Filderstadt, Germany 6Filderklinik, Filderstadt, Germany Abstract Overview: In hospitals with integrative paediatric departments and also in outpatient situations, children often receive a supportive anthroposophic treatment. These therapies are based on long-term experiences of anthroposophic physicians, but clinical trials validating these experiences are often missing. Therefore, we start a project to investigate anthroposophic multimodal therapy concepts in children. The aim of this study is to present validated therapy recommendations for frequent diseases in children (eg, acute gastroenteritis, pseudocroup). For this issue, we develop a 3-step process: (1) systematic literature search, (2) expert inquiry (Delphi-process) and (3) prospective documentation. In the first step available literature for complementary and alternative medicine-related therapies, with a focus on anthroposophic treatments, for the relevant disease are searched to provide an overview of applied therapy options. In the second step, a therapy recommendation is developed based on expert opinions collected in a Delphi process. Subsequently, our therapy recommendation regarding to effectiveness, safety and economic parameters will be verified in a prospective study in the departments of paediatrics at the Gemeinschaftskrankenhaus Herdecke and the Filderklinik (Germany). We concluded that these data will gain prestige to the anthroposophic medicine to a broader public and facilitate remedy selection for physicians in their fast-moving working routine. Rationale: As anthroposophic medicine is an important part of integrative medicine in Europe, especially in German-speaking countries, a scientific basis for these therapies is essential. Therefore, our project will contribute to scientifically underpin the use of anthroposophic treatments in childhood and make it more accessible for physicians as well as health insurance companies. Objectives: We present a scientific process with 3-steps for the reappraisal of anthroposophic treatment options for most frequent diseases in childhood. (1084) Descriptive Study of Medical Cannabis Patients in the Illinois Compassionate Use of Medical Cannabis Pilot Program: Opportunities for Improving Patient Care Leslie Mendoza Temple, MD1 and Sara L Lampert, BA2 1Northshore University Health System, Glenview, Illinois 2Lehigh University, Glencoe, Illinois Abstract Overview: This study examines 166 medical cannabis-certified participants in a North Chicago suburban Integrative Medicine practice. Patients were as young as 6 and as old as 96 years old. Mean age was 58 years; median age was 60 years. Race was predominantly Caucasian at 93.37%; 3.6% African-American; 1.8% Asian; 1.2% Hispanic. One hundred seventeen patients (70.5%) were female; 49 patients (29.5%) were male. Of the total cohort of 166 cases with medical cannabis cards, 117 patients (70.5%) were subjectively judged and coded through independent analysis of the physician’s progress notes to have successfully completed an adequate, self-directed trial of medical cannabis. Cancer, fibromyalgia, and seizures were the top 3 certified conditions in this medical practice. 88.0% of patients who completed an adequate trial of medical cannabis reported relief of 1 or more of their symptoms based on subjective review of the electronic medical record. Insomnia, chronic pain, and anxiety were the top 3 relieved symptoms. 29.1% patients reported encountering barriers to obtaining relief with cannabis. Barriers to use included undesired psychoactive effects, uncertainty regarding cannabis dose, frequency, route, and strain, and insufficient funds to obtain an adequate supply of medical cannabis. Opportunities exist to reduce these barriers and improve patient outcomes, safety, and satisfaction. Rationale: Illinois is the 20th state to approve a medical cannabis law in the United States of the 29 states plus the District of Columbia. With more than half of the United States having a medical cannabis law (and some with recreational use allowed), a growing number of patients are demanding medical cannabis for symptom relief for various conditions. This project highlights an Integrative Medicine practice in the north suburbs of Chicago, IL. The clinic has certified 166 patients with eligible debilitating conditions like fibromyalgia, cancer, epilepsy, multiple sclerosis, rheumatoid arthritis, Crohn’s disease, and others. Patients with these conditions are likely to engage in Integrative Medicine therapies which establish relevance of this project to the conference. This project highlights opportunities to study medical cannabis use to promote better outcomes, safety, and patient satisfaction through industry improvements in staff education; enhance dispensary-patient-physician communication; and streamline medical cannabis product offerings. The Illinois Compassionate Use of Medical Cannabis Pilot Program (MCPP) Act commenced on January 1, 2014, but experienced a prolonged hard start. The first dispensary opened on November 9, 2015. As of August 2017, approximately 23 300 patients were registered medical cannabis cardholders in Illinois, which is much less than estimated projections. Physician certification has also seen a slow start with only a handful of physicians writing a majority of the certifications. Patient demand may likely exceed supply of medical cannabis-certifying physicians in Illinois due to various factors including lack of education on cannabis efficacy, safety, dosage, strain, route, and potential drug interactions. Other factors contributing to low physician adoption of medical cannabis may include paucity of quality clinical evidence, cultural stigma, and/or lack of time during short office visits to name a few possibilities. Additional challenges to the success of the Illinois MCPP may include dispensary-related factors such as communication barriers due to logistic and legal obstacles, dispensary worker training variables, and inconsistent and varied cannabis products. Objectives: The aim is to learn about how physicians certify patients for medical cannabis eligibility; identify factors that can interfere with optimal patient outcomes and safety with medical cannabis usage, that is, dose confusion, financial limitations, side effects; learn about clinical outcomes seen in an early phase of a state’s medical cannabis program, with improvement in insomnia, pain, seizure, and nausea symptoms; and plan for quality improvement projects that can improve patients’ experiences with medical cannabis certification and dosing regimens. Examples include standardizing dispensary staff training; enhancing Health Insurance Portability and Accountability Act compliant communication between dispensary, physician, and patient; and streamlining medical cannabis product offerings from cultivators. (1088) Acupuncture as Adjuvant Therapy for the Management of Cervical Dystonia Danny Bega, MD1, Kelley Park, BA1, Ania Grimone, LAc, CH1, Fang Lin, LAc1 and Melinda Ring, MD2 1Chicago, Illinois 2Osher Collaborative for Integrative Medicine, Chicago, Illinois Abstract Purpose: There are no curative treatments for cervical dystonia (CD), therefore conventional management is aimed at pain relief and muscle relaxation. Many patients with CD use complementary and integrative/alternative interventions to manage symptoms, yet there is limited data on the use of acupuncture for CD. Results: Five subjects completed the study with only 1 acupuncture session missed by 1 subject, thereby meeting our predetermined adherence goal. All participants reported improvement from acupuncture. Only minor adverse events were reported, with self-resolved discomfort in 1 subject, and self-resolved minor bruising in 2 subjects. Data from exploratory efficacy end points including visual analog scale for pain, a clinician global impression of change, the Toronto Western Spasmodic Torticollis Rating Scale, and the Short Form (36) Health Survey are presented. Conclusions: Acupuncture is feasible and safe as an adjunct treatment for chronic CD, and it is associated with subjective symptomatic benefits. (1091) Comprehensive Lifestyle Change Program in Elderly Patients With Heart Failure Marta Alhama-Belotto, MD1, James Gray, MD1 and Christopher Suhar, MD1 1La Jolla, California Abstract Purpose: Cardiac rehabilitation has proven to be beneficial in patients with chronic heart failure (CHF). In this study, we studied the impact of adding a comprehensive lifestyle and psychosocial program to traditional cardiac rehabilitation in patients with CHF. Results: Eighteen patients were included, of which 11 were randomized to the intervention group. Mean age was 67.9 ± 15.7 and 74.6 ± 11.9 years in the intervention and placebo group, respectively. Mean ejection fraction (EF) was 31.3 ± 15.4 and 41.9 ± 10%. There were no statistical differences in terms of EF, New York Heart Association (NYHA) class, and guideline-directed medical therapy between groups. There was a trend toward more significant improvement in the 6 MWD in patients in the intervention group compared to placebo (63 vs −6 m change, P = .19, respectively), as well as in physical function (521 vs 393 score, P = .06, higher scores meaning better physical status) and depression (31.7 vs 54.4 score, P = .33, lower scores meaning less depression). There was a statistically significant improvement in left-hand grip (32.7 vs 22.1 kg, P = .003) and quality of life (QoL; 43% vs −6% improvement, P = .02) in patients who completed the program. No differences were seen in cognitive function or NYHA class between groups. Conclusions: A comprehensive program focused on lifestyle and spiritual well-being adds incremental benefit to CHF patients participating in cardiac rehab. Our program shows improvement in QoL and hand grip strength, and a trend toward better 6 MWD, physical function, and less depression in this population. (1093) Triggers of Psychological Trauma: A Tool to Empower Patients to Cope More Effectively Lesley M Teitelbaum, PhD1 and Ronald C. Fish, PhD1 1Psychological HealthCare PLLC, Syracuse, New York Abstract Overview: Trauma by its very nature overwhelms an individual’s physical, mental, and/or emotional resources, thereby rendering that person vulnerable to the memories related to that trauma. These memories can be precipitated by environmental stimuli and may be associated with negative behavioral coping responses. The consequences of trauma can shatter one’s concept of self and may be associated with diminished self-efficacy, intensified psychological symptoms, and threaten one’s ability to fulfill role responsibilities. Trauma survivors may encounter environmental cues that trigger memories of their traumatic experience that can intensify their psychological symptoms, diminish their self-efficacy and emotional well-being, and threaten their ability to fulfill their role responsibilities. To date, there are no instruments in the extant empirical literature to assist patients who have experienced trauma with coping with these environmental cues. We have developed a psychoeducational, clinical tool that includes a 6-step process (ie, reorienting, self-care, observing, refocusing, reframing, and revising) to help individuals who have been exposed to traumatic experiences cope more effectively with environmental cues that may trigger memories of those experiences. Each step offers a psychoeducational overview of a particular behavioral health technique with an associated exercise that offers patients an opportunity to apply that particular technique to their life circumstances. This tool is designed to be used in integrative health-care settings to (a) encourage patient engagement and inform behavioral health treatment decisions; (b) promote greater levels of self-awareness and increase ability to cope with environmental triggers more effectively; and finally, (c) encourage active engagement in the therapeutic process and promote post-traumatic growth. In summary, this clinical tool is designed to empower patients to overcome their instinctive, emotional reactions to environmental cues associated with their traumatic experience(s) and promote greater levels of self-awareness, self-efficacy, and emotional well-being in their day-to-day lives. Rationale: Trauma can impair emotional well-being as well as quality of life and is associated with increased risk of mental illness, substance abuse, physical health concerns, and early mortality. Implementing psychoeducational behavioral health tools within clinical settings can improve the assessment and treatment aspects of the therapeutic process. We have developed a psychoeducational, clinical tool to be used in integrative medicine and health settings to assist patients with coping with triggers of their traumatic experience and reengage with their world. This tool can be administered by nurses, or primary care providers, as well as behavioral health clinicians, to help patients develop new skills to cope with environmental triggers of traumatic experiences. This tool is desgined to facilitate patient engagement and help to guide and inform behavioral health treatment. Increasing one’s ability to cope with reminders of traumatic experiences can be an empowering experience that can improve the individual’s sense of self-efficacy and emotional well-being. Objectives: The objectives are 3-fold: (1) to develop and implement a clinical tool within behavioral health settings to help persons more effectively cope with triggers of traumatic events, reengage in the world, and reintegrate their traumatic experience into their identity; (2) to use this clinicial tool to promote engagement in behavioral health treatment, increase interdisciplinary communication, and inform treatment intervention strategies; and (3) to increase patient sense of empowerment, self-efficacy, and emotional well-being. (1100) Exploring the Role of Complementary and Integrative Health-care Providers in the Diagnosis and Treatment of Obesity Sara Diaz, David Victorson, PhD, Ashley Hite1, Beth Plunkett, MD, MPH2 and Rita Elue, MPH2 1Chicago, Illinois 2NorthShore University HealthSystem, Evanston, Illinois Abstract Purpose: To explore the role of integrative heath-care providers in the diagnosis and treatment of obesity. Results: A total of 67 people responded, 60 of whom met the inclusion criteria. Respondents represented 14 different professions including physicians (MD—47%), licensed acupuncturists (Lac—13%), registered dieticians (RD—8%), and nurses (RN/APN—8%). The accuracy of visual assessment of body mass index (BMI) was 45%, and providers underestimated weight category 44% of the time. This varied by the percentage of overweight/obese patients that providers reported seeing in their practice. Those who reported greater obesity management practices had higher accuracy than those who did not. Accuracy did not vary by provider’s BMI, experience, or profession. The majority of respondents correctly answered BMI knowledge questions (82%); however, only half said they regularly calculated BMI (55%) or used it to determine weight status (48%). The most commonly discussed interventions were physical activity, meditation/stress reduction, and dietary changes. Few providers reported feeling comfortable prescribing weight loss medications (15%) or discussing surgical interventions (18%). The most common barrier to weight management counseling was because the patient already knows that he/she is overweight or obese (52%). All (100%) MDs, RDs, Lac’s, and nurses agreed that it is their profession’s role to address obesity. Conclusions: Providers feel it is their role to address overweight/obesity and are frequent counselors; however, accuracy of visual inspection is low, providers use BMI infrequently and do not feel comfortable discussing medications or surgical interventions. (1101) Correlation Between Constipation and Coughing in a Patient With Interstitial Pneumonia Reflects the Traditional Chinese Medicine Theory of “Lung-gut Connection” Kosuke Mizoguchi, MD, PhD1, Masahiro Senju, MD, PhD2, Yusuke Goto, MD, PhD1, Ryo Yoshinaga, MD, PhD1, Hiroki Inoue, MD, PhD1, Hiromi Yano, MD1, Nobuyuki Yanagihara, PhD1, Eichi tahara, MD, PhD1 and Yoichi Nakamura, MD, PhD3 1Iizuka Hospital, Iizuka, Fukuoka, Japan 2Senju Hospital, Sasebo, Nagasaki, Japan 3Tochigi Cancer Center, Utsunomiya, Tochigi, Japan Abstract Overview: Background: According to traditional Chinese medicine, the lung and the intestine are a pair of related organ systems, although the lung has no direct anatomical connection with the intestine. This idea is still not a general medical concept in Western medicine, but recently, some studies have reported the correlation of constipation and bronchospasm, high prevalence of pulmonary involvement, and high cough sensitivity among patients with inflammatory bowel disease. Here, we had 1 rare case that suggested the correlation between constipation and coughing in a patient with interstitial pneumonia. Case report: A 61-year-old woman in the terminal stage of idiopathic interstitial pneumonia was suffering from severe cough. She also had chronic paralytic ileus and chronic constipation, therefore it was difficult to use codeine for cough suppression. When we tried using codeine on her, it was slightly effective, but we had to cease it soon after starting due to her abdominal distention and worsening of constipation. As a precondition to use codeine again, we tried to improve her chronic constipation with herbal medicine “Juncho-to” because usual laxatives were insufficient. It controlled her constipation successfully, and unexpectedly, her coughing was decreased to less than half of before and she did not need reuse of codeine. Improving her constipation may have contributed to suppression of her cough. Although the detailed mechanisms are still unknown, increased abdominal pressure associated with constipation might press the lung upward and stimulate cough reflex, or low-level systemic inflammatory process induced by chronic constipation might possibly increase cough sensitivity. Conclusion: In the case of the uncontrollable chronic cough associated with severe constipation concurrently, improving constipation might lead to control coughing from the standpoint of “lung-gut connection.” In addition, traditional herbal medicine is a good option of an alternative treatment. Rationale: It illustrated the necessity to see patients from both standpoints of Western and Eastern medicine rather than from either 1. Objectives: Knowledge that a new standpoint based on the traditional Chinese medicine theory of “lung-gut connection” may help in clinical settings and traditional Chinese herbal medicine is a good option of an alternative treatment. (1103) Exploring Mechanisms of Qigong Sensory Training Massage for Autism Kristin Jerger, MD, LMBT1 and Aysenil Belger, PhD1 1Chapel Hill, North Carolina Abstract Purpose: Despite the enormous worldwide prevalence of autism spectrum disorder (ASD), its full impact has yet to be realized. Millions of families worldwide need effective treatments to help them get through everyday challenges like eating, sleeping, digestion, and social interaction now and going forward. Qigong sensory training (QST) is a nonverbal, parent-delivered intervention recently shown to be effective at reducing these everyday challenges in children with ASD. This exploratory study aimed to (1) assess the feasibility of a protocol for studying biological mechanisms underlying QST’s clinical efficacy and (2) collect preliminary data of autonomic nervous system (ANS) and prefrontal cortex (PFC) activity for mechanism hypothesis generation. Results: Protocol feasibility was confirmed with 95% completion rate. Missing data (7.6%) were acceptable (<10%) but provided information to make technical changes for future studies. Although exploratory and not statistically significant, average high-frequency power midintervention was greater during the massage (2.9, standard deviation [SD] = 0.3) compared to video (2.5, SD = 0.5). PFC oxygenation decreased over time for both groups, except during emotional faces, when it tended to increase in the massage group with a concomitant drop in parasympathetic tone (P = .036). If replicated in a larger group, these preliminary results suggest a possible increase in PFC processing as a result of QST massage in autistic children. Conclusions: This study demonstrates solid protocol feasibility. Exploratory data suggest repeating this protocol with a larger sample could help clarify the relationship between ANS and PFC activity induced by QST. (1108) Social Interaction and Support Attenuate Pain-related Social Behavioral Disorder in Inflammatory Pain Rat Model Ruixin Zhang, PhD1, Fan Wu, PhD2, Ming Li2, Xinyun Yuan1, Xueyong Shen, MD2, Ke Ren, PhD1 and Brian M Berman, MD3 1Baltimore, Maryland 2Shanghai University of Traditional Chinese Medicine, Shanghai, China 3University of Maryland School of Medicine, Baltimore, Maryland Abstract Purpose: People with chronic pain show less social and recreational activities. It is not known, however, whether social interaction/support modulates pain-associated behavioral disorder. We hypothesize that social interaction/support attenuates pain-associated behavioral disorder by inhibiting the medial prefrontal cortex (mPFC) neuronal activities. Results: (1) Rats with persistent pain showed a significant loss of novelty preference to an unfamiliar rat; (2) social interaction/support from a same-sex cage mate restored the novelty preference in male rats; (3) yellow light stimulation inhibited neuronal spikes that were more frequent during pain; and (4) the yellow light stimulation of mPFC restored the novelty preference. Conclusions: Our data indicate that the mPFC neuronal activities may be correlated with social behavior disorder and inhibition of such activities attenuates these abnormal behaviors. Inhibition of cortex neuronal activities may be targeted for control of pain-associated behavioral disorder. Positive social interaction/support may provide an alternative strategy to help patients to cope with their condition. Supported by NIH R21 AT008467. (1109) A Food-based Dietary Supplement Containing a Low Dose of Iron Improved Markers of Iron Status and Quality of Life Among Nonanemic Iron Deficient Women Without Any Adverse Events Christopher R D’Adamo, PhD1, James Novick, MD2, Valerie Dawson, BS, MS-IV3, Larry Miller, PhD4 and Termeh Feinberg, PhD, MPH5 1University of Maryland School of Medicine, Baltimore, Maryland 2Charm City Research Group, University of Maryland St. Joseph Medical Center, Towson, Maryland 3Baltimore, Maryland 4Miller Scientific Consulting, Asheville, North Carolina 5Center for Integrative Medicine, Baltimore, Maryland Abstract Purpose: Iron deficiency is the most common nutrient deficiency in the world. While iron deficiency can often be resolved through dietary supplementation with iron, adverse events are common and frequently preclude compliance. The purpose of this study was to determine whether a food-based dietary supplement containing a very low dose of iron along with nutrients that increase iron absorption could resolve iron deficiency with fewer adverse events than typically reported at higher doses. Results: Twenty-three women participated in the clinical trial. Iron deficiency was resolved among the study sample (mean serum ferritin: baseline = 13.9 mg/L, 8 week = 21.1 mg/L, P < .001) and all other markers of iron status demonstrated clinically and statistically significant improvements (P < .04). Study participants also reported reductions in the frequency and severity of fatigue and increases in energy (P < .001). No adverse events were reported. Conclusions: While larger studies are needed, a low dose of iron with accompanying nutrients in this food-based dietary supplement resolved iron deficiency and improved all other markers of iron status without any adverse events. These findings suggest that lower doses of iron may be required if nutrients that increase the absorption of iron are included in the dietary supplement. (1111) An Ongoing Randomized Controlled Trial in an Urban Methadone Clinic: Lessons Learned and the Road Ahead Zofia Kozak1, Annabelle Belcher, PhD1, Luana Colloca, MD, PhD1 and Christopher Welsh, MD1 1Baltimore, Maryland Abstract Overview: Methadone (MTD), a full mu-receptor opioid agonist, is a commonly prescribed medication for opioid use disorder. A physician works closely with patients to prescribe a dose that manages withdrawal symptoms and craving, which are self-reported by the patient. The placebo effect reduces symptom severity in a variety of diseases and may extend the therapeutic index of pain analgesics via a placebo dose extension (PDE) paradigm. This RCT, conducted in a West Baltimore city MTD clinic, examines the potential role of open-label placebo administered within a PDE paradigm. Conducting this study in a high-volume, inner-city MTD clinic presented several unique challenges. One notable difficulty was integrating the study protocol into an already-congested clinic workflow. Patients were approached to participate in the study on their first day of treatment, when they typically have 4–6 h of intake procedures with a variety of clinic personnel, from therapists to payment counselors. Fitting the RCT study measurements into an already nonlinear intake process proved to be a primary challenge. Other challenges included completing intake procedures/study questionnaires while participants were experiencing acute opioid withdrawal (ie, prior to dosing), and maintaining participant contact and follow-up, most of whom were housing unstable. These challenges are redeemed by the invaluable insights this study provides into the pulse of Baltimore’s opioid epidemic. In this community-based setting, all participants were enrolled in a local MTD treatment program and recruited directly from this ground source. In contrast, an RCT conducted in a traditional research setting recruits outside patients to participate in the specific research trial and often has infrastructure setup to facilitate the clinical protocol. The demographics of such participants and this specific infrastructure makes the study less susceptible to the challenges described above; however, this may be at the expense of obtaining a representative cross-section of the target population being studied. Rationale: Drug use is endemic throughout the United States and increasing amounts of research dollars are spent investigating interventions to stem this public health emergency. Addiction is a complex phenomenon to study, as there are a wide range of factors thought to contribute to its onset and progression. Research settings that closely resemble the natural environment of those affected by the disease may be able to provide the most accurate and representative insights. However, conducting such RCTs comes with unique challenges. Having studied addiction both in a clinical setting (such as this) and research setting with the National Institute on Drug Abuse, the presenting author (Zofia Kozak, MSII at University of Maryland, School of Medicine), will discuss the challenges and benefits of conducting addiction research in a community clinical setting. Objectives: The aim is to learn about unique challenges faced by an RCT studying addiction within an urban, community MTD clinic; discuss the benefits of conducting clinical research, particularly studying addiction, in a setting that is interwoven with participants’ typical daily routine (ie, within the walls of a community MTD clinic vs a research setting); and learn about how the placebo response, which involves mind/body interactions, may be ethically harnessed in clinical practice and about its potential in improving outcomes in MTD-maintained patients. (1112) Reliability of Ayurvedic Diagnosis for Knee Osteoarthritis Patients—A Nested Diagnostic Study Within a Randomized Controlled Trial Christian S Kessler, MD, MA1, Andreas Michalsen1, Claudia M Witt2, Antonio Morandi, MD3, Abhimanyu Kumar4, Kartar S Dhiman5, Shivenarain Gupta6, Katja Icke7, Carina Bühner, MD1, Elmar Stapelfeldt, MA1, Manfred B Wischnewsky8, Ludwig Kronpaß, MD9 and Vijayendra Murthy, MD10 1Immanuel Hospital Berlin and Charité Medical University, Berlin, Germany 2University Hospital Zurich, University of Zurich, Zurich, Switzerland 3Ayurvedic Point, Milan, Italy 4All India Institute of Ayurveda, New Delhi, India 5Central Council for Research in Ayurvedic Sciences, New Delhi, India 6J.S. Ayurveda College & P.D. Patel Ayurveda Hospital, Nadiad, India 7Datamanager, Charité – Universitätsmedizin Berlin, Berlin, Germany 8University of Bremen, Bremen, Germany 9AyurSan-Zentrum Sankt Salvator, Sankt Salvator, Germany 10University of Southampton, Southampton, UK Abstract Purpose: Ayurveda is a traditional Indian system of medicine. The customized Ayurvedic approach consists of a combination of several diagnostic procedures and subsequent individualized therapeutic interventions. Evaluation of interrater reliability of Ayurvedic diagnoses has rarely been performed. Aim of this study was to evaluate interrater reliability of Ayurvedic diagnosis for patients with knee osteoarthritis. Results: One hundred twenty different ratings and 30 consensus ratings were performed and analyzed. While high percentages of agreement for main diagnostic entities and the final Ayurveda diagnosis (95% consensus agreement on main diagnosis) could be observed, this was not reflected by the corresponding kappa values, which largely yielded fair to poor interrater agreement kappas for central diagnostic aspects such as prakriti and agni (κ values between 0 and 0.4). Notably, agreement on disease related entities was better than those of constitutional entities. Conclusions: This is the first diagnostic study embedded in a clinical trial on patients with knee osteoarthritis utilizing a multimodality whole systems approach. Results showed a contrast between the high agreement of the consented final diagnosis and disagreement on certain diagnostic details. Future diagnostic studies should have larger samples sizes and a methodology more tailored to the specificities of traditional whole systems of medicine. Equal emphasis will need to be placed on all core diagnostic components of Ayurveda, both constitutional and disease-specific, using detailed structured history taking forms. (1114) Development and Psychometric Properties of the Mindfulness Self-efficacy Scale Gurjeet S Birdee, MD, MPH1, Kenneth A Wallston, PhD1, Sujata G Ayala, MPH1, Edward H Ip, PhD1 and Stephanie J Sohl, PhD1 1Winston-Salem, North Carolina Abstract Purpose: Mindfulness meditation is a popular Eastern-based technique that improves quality of life. Participants in mindfulness meditation interventions report a wide range of adherence to home practice. Understanding self-efficacy for mindfulness meditation may improve understanding of adherence variability. Self-efficacy also affects health behavior and is associated with health outcomes. The purpose of this study was to develop and examine the psychometric properties of a self-efficacy measure for mindfulness meditation practice (Mindfulness Self-Efficacy Scale [MSES]). Results: A majority of participants were White (95%) and female (74%). The 9-item MSES was unidimensional with 3 subconstructs of attention, compassion, and emotion. The omega hierarchical coefficient for the total scale was 0.78, and test–retest reliability was intraclass correlation coefficient = 0.85 (95% confidence interval: 0.80, 0.89). MSES scores were positively correlated with the Perceived Health Competence Scale (rho = 0.41), the 5 Facet Mindfulness Questionnaire (observing, rho = 0.42; describing, rho = 0.47; Nonreactivity, rho = 0.72; Acting with awareness, rho = 0.48; nonjudging, rho = 0.54), the Global Health Scale from the Patient-Reported Outcomes Measurement Information System (physical health, rho = 0.27; mental health, rho = 0.58), and a Social Desirability Scale (rho = 0.42). Conclusions: This study provides preliminary evidence that MSES is a reliable and valid measure of self-efficacy for mindfulness meditation practice that may provide insight into barriers to adopting and maintaining mindfulness meditation as a health behavior that improves quality of life. (1124) An Integrative Medicine Elective Rotation: Pre–Post Changes on Well-being and Wellness Behaviors Audrey J Brooks, PhD1, Ann Marie Chiasson, MD, MPH1, Racquel Bustamante, BA1, Victoria Maizes, MD1 and Mei-Kuang Chen, PhD1 1Tucson, Arizona Abstract Purpose: To examine changes in well-being and wellness behaviors in medical students and residents participating in a 4-week Integrative Medicine elective rotation. Results: Four cohorts of participants have enrolled in this 1-month rotation (N = 115), with most completing both pre- and posttest assessments (N = 83). Statistically significant (P < .05) pre–post changes were observed for all well-being measures with the exception of emotional intelligence. Decreases in perceived stress, negative affect, depression, emotional exhaustion, and depersonalization and increases in positive affect, mindfulness, physician empathy, life satisfaction, and personal accomplishment were observed. Changes in wellness behaviors including frequency of days staying hydrated, servings of fiber, mind–body/spiritual practices, socializing, quality sleep, and enjoying work increased; days eating animal protein, red meat, drinking caffeinated beverages, and work stress decreased. Greater increases in frequency of mind–body practices were associated with greater improvements on burnout, mindfulness, emotional intelligence, stress, affect, and depression (P < .05). Conclusions: A 4-week elective teaching core aspects of Integrative Medicine for both patient and practitioner health and well-being has a significant positive impact on student and resident burnout, well-being, and self-care behaviors. Integrative Medicine curriculum taught in medical school or residency must be considered when designing medical curriculum that incorporates physician well-being. (1136) Association of Diet Quality With Overall Fibromyalgia impact, and Psychosocial and Quality of Life Outcomes in Women With Fibromyalgia Mei Chung, PhD, MPH1, Chenchen Wang, MD, MSc2, Andrew Beauchesne, MS1, Zhuxuan Fu, MPH1 and Lori Lyn Price, MAS2 1Tufts University School of Medicine, Boston, Massachusetts 2Tufts Medical Center, Boston, Massachusetts Abstract Purpose: Lifestyle modifications, including of diet and exercise, have been widely disseminated for the prevention and treatment of chronic pain. However, the relationships between dietary habits and fibromyalgia (FM) impact, and psychosocial or quality of life (QoL) outcomes have not been well studied. Results: A total of 26 female participants (mean age = 56 years; mean pre-intervention body mass index = 29.6) were included in the analyses. Of which, 6 (3 in each intervention arm) participants reported that their diet has changed since the end of the original trial. Diet quality of these participants was better than general U.S. adult population (Table 1). Higher pre-intervention self-efficacy and physical health QoL were associated with higher diet quality (r = .62 and .32, respectively). Higher pre-intervention levels of anxiety and depression were associated with lower diet quality (r = −.43 and − .47, respectively). There were no significant associations between diet quality and pre-intervention severity of depressive symptoms, mental health QoL, sleep quality, or FM impact scores (Table 2). Conclusions: Better diet quality as recommended by the 2010 Dietary Guidelines for Americans may be associated with more favorable psychosocial and physical health QoL outcomes in women with FM. Our results are consistent with a large cross-sectional study in women with FM from Spain (J Acad Nutr Diet. 2017 Mar;117(3):422–432). Future studies evaluating the effects of healthy dietary patterns on psychosocial and physical outcomes in individuals with FM are warranted. (1139) Effect of a 6-Week Yoga and Meditation Program on Medical Students’ Stress Levels and Sense of Well-being Prior to Taking Exams Lona Prasad, MD1, Aneesha Varrey, MD2 and Giovanni Sisti, MD3 1New York, New York 2Wayne State University, Detroit, Michigan 3Bronx Lebanon Hospital, New York, New York Abstract Purpose: Medical students’ stress is essential for academic achievement. However, persistent stress may compromise performance and personal health. Our study’s purpose was to determine the effect of 6-weeks of yoga and meditation on medical students’ perceived stress and sense of well-being prior to exams. Results: A total of 13 women and 14 men participated. Median age was 28 (24 years–32 years); 48.1% Caucasian, 7.4% Black, 11.1% Hispanic, 11.1% Asian, and 22.2% other. Paired t tests showed a significant reduction in perceived stress (18.44 vs 14.52; P = .004) after 6 weeks. The Wilcoxon signed-rank test showed a significant improvement in feelings of peace, focus, endurance, and fatigue. No significant changes in happiness, positivity, personal satisfaction, self confidence, or patience were seen. Conclusions: Results show 6 weeks of yoga and meditation significantly reduced stress and improved aspects of personal well-being. A future larger study including a control group may help to validate these results. (1141) Integrating Psychology Into Integrative Medicine: A Pilot Clinical Service and Training Program in Supportive Cancer Care Elizabeth L Kacel, MS, Irene M Estores, MD1 and Deidre B Pereira, PhD1 1University of Florida, Gainesville, Florida Abstract Overview: Integrative Medicine approaches to symptom management are gaining popularity among cancer patients with unmet supportive care needs. While chronic problems faced by cancer survivors are often physical in nature, many patients also experience persistent psychological distress and impairment. This presentation will describe a pilot collaboration between Psychology and Integrative Medicine at a large academic medical center in the Southeastern United States that is designed to evaluate and treat medical and psychological symptom burden among cancer patients and survivors. We will explore ways in which this innovative dyadic consultation model may positively affect clinical practice, training programs, and research initiatives. Rationale: Integrative Medicine services are often provided by physicians and specialized practitioners (eg, massage therapist, acupuncturist). Only select programs around the United States include psychologists who are expertly trained in addressing the behavioral aspects of disease and symptom management and the emotional concerns of cancer patients. This presentation will demonstrate how collaboration between Integrative Medicine and Psychology may (1) identify patients with psychological problems that may influence adjustment to cancer and/or adherence to medical intervention and (2) increase efficiency by triaging patients to determine the level of psychological intervention, if any, they require. We will present preliminary data on patients seen in the first 6 months of this program. Objectives: The goals of this session are (1) to present a pilot collaboration of service provision and training between Psychology and Integrative Medicine within supportive oncology care, (2) to discuss the ways in which collaboration between these specialties may optimize behavioral health (eg, sleep, pain, mood, adherence) and maximize emotional well-being among cancer patients and survivors, (3) to describe the ways in which this type of collaboration may improve continuity of care and efficiency from an operations perspective, and (4) to explore potential avenues for additional collaboration via training and research initiatives. (1142) Nonpharmacological Treatment on Fatigue, Depression, Disease Activity, and Quality of Life of Systemic Lupus Erythematosus: A Systematic Review Monthida Fangtham, MD, Jacob Louis Nash, MSLIS, Stephanie Hyon, MS1, Raveendhara R Bannuru, MD, PhD2 and Chenchen Wang, MD, MSc2 1Boston, Massachusetts 2Tufts Medical Center, Boston, Massachusetts Abstract Purpose: In recent years, nonpharmacological therapies have been deemed as potentially beneficial for patients with systemic lupus erythematosus (SLE). These include complementary and integrative approaches, physical and psychological interventions. We conducted the systematic review to determine the effects of these therapies to inform practice in SLE patients. Results: Nine randomized controlled trial (RCT) studies totaling 651 participants met the inclusion criteria and were included in this review. SLE disease duration ranged between 2.5 and 12 years, mean age ranged from 13 to 48 years, and 96% were female. The quality of trials was generally moderate to good. Table 1 summarizes the RCTs evaluating the effects of nonpharmacological treatment in patients with SLE. Of the 9 trials, 4 used exercise interventions, 4 used psychological interventions (1 group psychotherapy, 2 cognitive behavioral therapies, 1 psychoeducation intervention), and 1 used electroacupuncture. Three of the 9 studies utilized control groups consisting of usual medical care. Other studies included control interventions of relaxation, attention placebo, symptom monitoring support, minimal needling, and isotonic and resistance exercise. Compared with the control conditions, nonpharmacological interventions were associated with a significant improvement in fatigue in 3 of the 4 studies (1 exercise, 1 psychological, and 1 acupuncture intervention). Four studies reported improvement in overall quality of life as measured by Short Form-36, compared to control. Two of the 6 studies also reported improved anxiety and depression, and 3 studies improved pain after interventions. However, 1 psychotherapy study did not find any clinically important improvement in psychological distress, disease activity, and quality of life compared to usual care. Also, no studies demonstrated a greater improvement in disease activity with 6–20 weeks of nonpharmacological interventions. Conclusions: The review showed promising results for physical exercise and psychological interventions as an adjunct to traditional medical therapy for improvement in fatigue and quality of life. However, many studies had small sample sizes and short intervention durations. Further high-quality RCTs with longer follow-up periods are warranted. References 1. Tench 2003. 2. Bogdanovic, 2015. 3. Abrahão, 2016. 4. Prado, 2013. 5. Karlson, 2004. 6. Dobkin, 2002. 7. Greco, 2004. 8. Navarrete, 2010. 9. Greco, 2008. (1149) Improving Boston’s Health Network: Identifying Neighborhood-level Stress Sources, Stress-related Behaviors, and Health Problems Frank Conyers, BS1, Darshan Mehta, MD2, Helene Langevin, MD2 and Gary Badger, MS2 1Osher Center, Brigham and Women’s Hospital, Norwood, Massachusetts 2Burlington, Vermont Abstract Purpose: The role chronic stress plays in the development of health disparities was demonstrated in recent studies that established the relationship between neighborhood characteristics and idealized health measures. However, the relationship between neighborhood stressors and their effect on stress-related health problems and behaviors is unknown. In Boston, MA, the neighborhoods of Roxbury, Jamaica Plains, and Back Bay, while within a 3 mile radius, have widely divergent life expectancies (59, 78, and 89, respectively). This work aims to map the distribution of perceived neighborhood-level stressors, stress-related negative behaviors, and stress-related health problems in these 3 neighborhoods. Results: Mean age was 58.1 years, with 52% women. There were statistically significant differences in stressors across neighborhoods for 19 of the 27 questions (Analysis of variance P values <.02). The largest neighborhood stressors were (1) Roxbury—cost of living, addiction, and discrimination were the largest stressors (mean score: 4.1, 3.8, and 3.0, respectively); (2) Jamaica Plain—housing costs, addiction, and unsafe pedestrian/bike access (mean: 3.1, 2.8, and 2.0, respectively); and (3) Back Bay—unsafe pedestrian/bike access, lack of affordable fitness facilities, and noise pollution (mean: 3.2, 2.9, and 2.4, respectively). The highest reported stress-related health problems were—(1) Roxbury—addiction, obesity, and lack of exercise; (2) Jamaica Plain—addiction, insomnia, and chronic pain; and (3) Back Bay—anxiety, chronic pain, and insomnia. The largest stress-related behaviors were—(1) Roxbury—addiction, physical violence, and child abuse; 2) Jamaica Plain—poor diet, addiction, and lack of exercise; and 3) Back Bay—aggressive driving, lack of exercise, and intolerance. Conclusions: The marked contrasts between the 3 neighborhoods could guide strategies for improving the health of neighborhoods and individuals. Further research is needed to investigate how stressors are embedded into specific neighborhood environments and which interventions would best target these barriers. (1151) A Cost-effectiveness Analysis of Yoga for Chornic Low Back Pain Lin Liu, PhD1, Laura Schmalzl, PhD2 and Erik J Groessl, PhD1 1La Jolla, California 2Southern California University of Health Sciences, Whittier, California Abstract Purpose: Yoga interventions can improve function and reduce pain in persons with chronic low back pain (CLBP). Using data from a recent trial of yoga for military veterans with CLBP, we analyzed the incremental cost-effectiveness of yoga versus the study comparator. Results: At 6 months, 43 (57%) yoga participants had a chronic multisymptom illness compared with 18 (24%) of the DT group (P = .003). The yoga group had significantly greater increases in EQ5D scores than the DT group (mean change difference = 0.063; P = .047). Adjusting for lead-in effects and diminishing effects from 6 to 12 months, quality-adjusted life years (QALYs) gained over 1 year were estimated as 0.041. Total intervention costs including estimated overhead were $550 per yoga participant and $85 per DT participant. Health-care costs were assumed to be equal based on very similar utilization and AE data. The incremental cost-effectiveness ratios (ICERs) were $1,395 per clinically improved patient at 6 months and $11,341/QALY over 1 year. To adjust for inflated intervention costs resulting from conducting a randomized controlled trial in a limited time frame, a sensitivity scenario estimated that costs for an ongoing yoga intervention could be delivered at about half the cost or $287/participant. In this scenario, ICERs are lowered to $606 per clinical improvement at 6 months and $4,927/QALY. Conclusions: The results suggest that yoga, which is typically delivered in a group format, is a relatively low-cost intervention and has a favorable cost-effectiveness ratio. Using intent-to-treat data, yoga was delivered for about $23 per session/participant and has been shown to produce equivalent benefits to physical therapy which is often reimbursed at $100 per 60-min session. (1155) Mindfulness for Chronic Pain: A Systematic Review and Meta-analysis Lara G Hilton, MPH1, Susanne Hempel, PhD1, Alicia Maher, MD1, Eric Apaydin, PhD1, Lea Xenakis, MPA1, Newberry Sydne, PhD1, Melony Sorbero, PhD1 and Maglione Margaret, MPP1 1RAND Corporation, Santa Monica, California Abstract Purpose: Chronic pain, often defined as pain lasting longer than 3 months, can lead to significant medical, social, and economic consequences; lost productivity; and larger health-care costs. Chronic pain patients increasingly seek treatment through mindfulness meditation. Our aim was to synthesize evidence on efficacy and safety of mindfulness meditation interventions for the treatment of chronic pain. Results: Thirty-eight randomized controlled trials (RCTs) met inclusion criteria; only 2 reported on safety. Interventions included mindfulness-based stress reduction, mindfulness-based cognitive therapy, and other mindfulness interventions. Medical conditions reported included fibromyalgia, back pain, osteoarthritis, rheumatoid arthritis, headache/migraine, irritable bowel syndrome, and others. We found low-quality evidence that mindfulness meditation is associated with a decrease in pain compared to all controls in 30 RCTs. Statistically significant effects were also found for depression and health-related quality of life. The efficacy of mindfulness meditation on pain did not differ systematically by type of intervention, medical condition, length, or frequency of intervention or whether offered as mono- or adjunctive therapy. Conclusions: Mindfulness meditation improves pain symptoms, depression, and quality of life; however, quality of evidence for outcomes is low to moderate due to substantial heterogeneity and mixed quality of included RCTs. Additional trials with adequate power, greater efforts to prevent attrition, monitoring of adherence to meditation practice, active collection of adverse events, and better reporting of methods are suggested to decisively provide estimates of the efficacy of mindfulness meditation for chronic pain. (1157) Meditation or Exercise for Preventing Acute Respiratory Infection: A Randomized Controlled Trial Bruce Barrett, MD, PhD1, Mary S Hayney, PharmD1, Daniel Muller, MD, PhD2, David Rakel, MD1, Roger Brown, PhD1, Aleksandra E Zgierska, MD, PhD1, Mary M Checovich, MS1, Shari Barlow, BA1, Supriya Hayer, MD1, Jodi H Barnet, MS1, Elisa R Torres, PhD1 and Christopher L Coe, PhD1 1Madison, Wisconsin 2University of Colorado, Fort Collins, Colorado Abstract Purpose: The Meditation or Exercise to Prevent Respiratory Infection (MEPARI-2) trial was designed to replicate and extend MEPARI-1 findings of reduced acute respiratory infection (ARI) in people who received meditation or exercise training. Results: Of 413 participants randomized (76% female, 85% white, mean age 49·6 ± standard deviation 11·6 years), 390 completed the trial. In the mindfulness-based stress reduction (MBSR) group, 74 experienced 112 ARI episodes with 1045 days of ARI illness. Among exercisers, 84 had 120 episodes totaling 1010 illness days. Eighty-two of the controls had 134 episodes with 1210 days of ARI illness. Mean global severity was 315 for MBSR (95% confidence interval 244–386), 256 (193–318) for exerciser (EX), and 336 (268–403) for controls. A prespecified multivariate zero-inflated regression model suggested reduced incidence for MBSR (P = .036) and lower global severity for EX (P = .042), compared to control, but not attaining the P < .025 prespecified for null hypothesis rejection. There were 73 ARI-related missed-work days and 22 ARI-related health-care visits in the MBSR group, 82 days and 21 visits for EXs, and 105 days and 24 visits for controls. On average, meditators used 28 (23–32) medications per ARI episode, similar to controls 29 (26–32). Exercisers used fewer medications than controls 22 (18–26), P = .001. Conclusions: Observed incidence, duration, severity, and impact of ARI illness were modestly lower among people trained in meditation or exercise than in observational controls. Further research is needed to confirm these effects and to inform clinical practice and health policy. (1162) Acupuncture for Pediatric Chronic Pain Relief: A Review Yujuan Zhang, MD, Stephanie Hyon1 and Chenchen Wang, MD, MSc2 1Boston, Massachusetts 2Tufts Medical Center, Boston, Massachusetts Abstract Overview: Evidence of the effect of acupuncture for pediatric chronic pain is scarce. We have performed a review evaluate the effect of acupuncture on chronic pain in pediatric subjects. Rationale: Our review suggests that current evidence supports acupuncture as a safe and helpful alternative treatment of chronic pain in the pediatric population but is insufficient for a definitive conclusion. Rigorous and well-controlled randomized trials are warranted. Objectives/Background: Acupuncture, a type of complementary and integrative therapy, has been widely used for pain relief in adults. However, evidence of the effect of acupuncture for pediatric chronic pain is scarce. We evaluate the effect of acupuncture on chronic pain in pediatric subjects. Methods: We performed a comprehensive search of Eastern and Western databases in MEDLINE and Chinese databases: China Hospital Knowledge Database, China National Knowledge infrastructure, WanFang Data, and Traditional Chinese Medical Database System until January 2017. Selection criteria included clinical trials and observational studies of acupuncture in pediatric chronic pain patients, sample size ≥8, and outcome measures included pain evaluation. Results: We identified 142 potentially relevant studies. Eight studies (total 493 participants) met eligibility criteria. Of the 8 studies, 1 was randomized controlled trial, 5 were nonrandomized controlled trials, and 2 were retrospective chart reviews. Four used traditional Chinese acupuncture, 1 used Korean hand acupuncture and 1 used Japanese style needle, the other 2 were unclear. Table 1 summarizes the studies evaluating the effect of acupuncture on pain measured with a pain scale on exam. More than 90% of subjects were able to complete all treatments acupuncture was associated with a significant pain reduction in 7/8 studies. All 8 studies reported improvement in pain-related function after treatments. Four of the 8 studies showed a reduction in pain by 3 to 5 points on pain scale; 3/8 studies reported either a high percentage of improvement in pain (70% ∼ 96%) or a statistically significant reduction on pain scale (1.5 point, P < .001). One study reported subjects with chronic fatigue had improved function (P < .01). None of the studies reported any adverse effects related to the acupuncture treatment, with 7 studies clearly stating that there were no adverse effects from the acupuncture treatment. Discordant trial designs, varying outcome measures, and methodological limitations precluded a pooled meta-analysis. Conclusion: The current evidence suggests that acupuncture appears to be safe and helpful in the treatment of chronic pain in the pediatric population but is insufficient for a definitive conclusion. Rigorous and well-controlled randomized trials are warranted. References 1. Pintov S, Lahat E, et al. Pediatr Neurol. 1997;17:129–133. 2. Jodorkovsky R. Med Acupunct. 1999;Spring/Summer(11):1. 3. Kemper KJ, Sarah R, et al. Pediatrics. 2000;105(4 Pt 2):941–947. 4. Lin Y-C, Bioteau A, Lee AC. Med Acupunct. 2002;14(1):45–46. 5. Zeltzer LK, Tsao JC, et al. J Pain Symptom Manage. 2002;24(4):437–446. 6. Lin Y, Ly H, Bioteau AB. Acupunct Med. 2004;(16):21–23. 7. Lin YC. ASA Annual Meeting Abstract; October 13–17, 2007; San Francisco, CA. 8. McDonald MJ. Med Acupunct. 2015;27(6):481–486. (1163) Research on a Traditional Chinese Medicine-related Generation Tea With the Efficacy of Antihypertension and Lipid Lowering Hui H Zhao1, Li Xue Li1, Ming Gong1, Pei P Wang1, Xi Tan1, Juan Wang1 and Wei Wang1 1Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: Wuweijiangyasan was stem from the empirical formula of veteran doctors of Traditional Chinese Medicine (TCM), which consists of Cortex lycii, Gegen, Danshen, Hawthorn, and Burdock root. Meanwhile, it has the function of purging liver fire, nourishing the Yin fluid of liver and kidney, and the effect is either heat clearing and detoxicating or promoting blood circulation to remove blood stasis. It is also acknowledged for tonification and purgation in combination, Qi and Blood used simultaneously, to cure the hypertension with the syndrome of TCM in liver and kidney’s Yin deficiency. Therefore, Wuweijiangyasan has been known for its reliable effective on antihypertension in clinical, which is valid for more than 85% hypertension patients. Even more noteworthy is that Wuweijiangyasan not only safe but also without side effects. The characteristics of the formula resulted from its simple composition, less ingredients, small dosage, and the 5 Chinese medicines are very common to see in clinical. At the same time, Wuweijiangyasan is easy to obtain at a low price with significant quality and efficiency. The directions for hypertension patients to use are as follows: cortex lycii, Gegen, Danshen, Hawthorn, and Burdock root are each 3 g, then put them together in a cup and pour boiling water to stewing for about half an hour to make tea substituted. It just need to take 3 times a day, respectively, after breakfast, a nap, and supper walk. The more crucial is to have the antihypertension tea persistently. According to the antihypertensive effect of the Wuweijiangyasan in clinical, then do animal basic research to verify the antihypertensive effect of traditional Chinese medicine for tea substituted. In the meantime, to study the effect of Wuweijiangyasan on the systolic blood pressure and blood lipid in spontaneously hypertensive rats (SHR). Results: Wuweijiangyasan showed significant antihypertensive effect on the fourth weeks medication (P <. 05); at the same time, the detection results of the SHR serum biochemical indexes even showed that cholesterol (CHOL), triglycerides (TG), and low-density lipoprotein C (LDL-C) in blood lipid were reduced to a certain extent. Conclusions: Wuweijiangyasan showed significant antihypertensive effect on the fourth weeks medication (P < .05); at the same time, the detection results of the SHR serum biochemical indexes even showed that CHOL, TG, LDL-C in blood lipid were reduced to a certain extent. (1164) An International Exploration of “Purpose-built” Art in Hospitals Judy A Rollins, PhD1 1Washington, DC Abstract Purpose: The effects of viewing hospital artwork on stress reduction and other medical outcomes is a growing area of investigation with implications for integrative, holistic health. Disagreement exists about whether hospital art is intended to challenge and provoke in addition to soothing and comforting. A movement has emerged for unique “purpose-built” artwork designed to promote other positive outcomes for patients, family, and staff. Research to date is slim and primarily anecdotal. This international study, conducted as a scholar at The Institute of Integrative Health, sought to identify examples of this type of art and to explore the perceptions of the individuals who create, select, or use this art; the principles that guide creation and selection; and evidence regarding outcomes for individuals exposed to the art. Results: Bespoke artwork was identified throughout the world. Analysis revealed 8 major categories of purpose: (1) meditative, (2) inspirational, (3) interactive, (4) remembrance, (5) messaging, (6) cultural, (7) empathetic, and (8) community. Styles ranged from ambiguous and abstract to realistic. Themes included patient experience, infection control, artist-initiated “extras,” and the need for outcomes research. Some hospitals are conducting or planning research, yet most cite lack of resources to do so. Conclusions: Findings indicate that hospital art is used for purposes other than soothing and comforting and suggest that such art can have a positive impact on individuals. Although most evidence remains anecdotal, momentum is building for rigorous research in this area. (1167) Competencies Developed for Hospital-based Massage Therapy Dale Healey, DC, PhD1, MK Brennan, RN, MS, LMBT2, Carolyn Tague, MA, CMT3 and Beth Rosenthal, MPH, MBA, PhD4 1Northwestern Health Sciences University, Bloomington, Minnesota 2Carolinas HealthCare System University Hospital, Charlotte, North Carolina 3Laguna Honda Hospital, San Francisco, California 4Academic Collaborative for Integrative Health, Chicago, Illinois Abstract Overview: As massage therapy experiences a resurgence of use for hospitalized patients, it is appropriate to consider competencies needed to practice in these settings. The hospital environment differs vastly from other massage practice locations such as private offices, spas, and sports clubs. The variety of conditions presented by the patients requires the ability to adapt massage protocols appropriately. With this in mind, the Hospital-based Massage Therapy Task Force was formed to determine whether there is a need for standard competencies for hospital-based massage therapy (HBMT)_. If indicated, the group would develop a peer reviewed set of competencies, which could be useful to hospitals, massage therapy schools, and massage therapists. The members of the task force identified massage therapists who worked in hospitals and hospitals known to them that had massage therapy programs. A survey was created and distributed to those who agreed to participate. The purpose of the survey was to assess various elements of their massage therapy programs such as educational/experience requirements, employment status, orientation, and supervision. Thirty-two of the 37 hospitals completed the survey, resulting in an 87% response rate. The Task Force considered the high response rate and the extent to which respondents provided in-depth information to the open-ended questions as support for a standard set of HMBT competencies for safe and effective massage therapy for hospitalized patients. In addition to the survey, the task force used a Delphi technique to engage survey participants and other experts in the field to shape the initial draft of the competencies. The resultant competencies specific to HMBT build on the Academic Collaborative for Integrative Health (ACIH) Competencies for Optimal Practice in Integrated Environments. As these competencies are shared with hospitals, massage therapists, and massage schools, the Task Force members expect that additional development of the competencies will take place as various groups implement them. Rationale: The set of HBMT-specific competencies created include some of the ACIH Competencies most relevant to HBMT and additional competencies that specifically address practical issues relevant to HBMT practice. As such, we determined the following 3 areas for the HBMT competencies: hospital environments, massage practice, and therapeutic presence. Hospital environments includes values and ethics, charting, medical terminology, communication with hospital staff, evidence-informed decision-making, roles and responsibilities, credentialing, and informed consent. Massage practice competencies are focused on understanding medical conditions and appropriately adjusting massage protocols as well as understanding indications, contraindications, and precautions. The ability to work around medical equipment, demonstrating correct body mechanics, and recognizing one’s limitations in this environment are also included in this competency category. Therapeutic presence focuses on working relationships in the hospital environment with patients including appropriate boundaries, communication, and self-care. Objectives: As a result of this session, participants will be able to discuss the process used by the HBMT Competencies Task Force to investigate the need for HBMT competencies; discuss the process used by the HBMT Competencies Task Force to develop HBMT competencies, including their relationship to the ACIH Competencies for Optimal Practice in Integrated Environments; Discuss the need for HBMT competencies; and consider ways in which the HBMT competencies could be disseminated for use by hospitals, schools, and practitioners. (2167) Impact of Lactulose Breath Testing Thresholds on the Diagnosis of Small Intestinal Bacterial Overgrowth Ryan Bradley, ND, MPH1, Doug Hanes, PhD1 and Laurie Menk Otto, ND, MPH1 1National University of Natural Medicine, Portland, Oregon Abstract Purpose: To evaluate the impact of lactulose breath testing (LBT) interpretation thresholds on the diagnosis of small intestinal bacterial overgrowth (SIBO). Results: In the 20 symptomatic participants, the frequency ratio of symptomatic LBT+:LBT− was 18:2, 15:5, and 19:1 based on community, published, and lab criteria, respectively, with “positive” results in 90%, 75%, and 95% of the sample, respectively. In the 96 asymptomatic participants, the frequency ratio of LBT+:LBT− was: 64:32, 63:33, and 71:25 based on community, published, and lab criteria, respectively, with “positive” results in 67%, 66%, and 71% of the sample, respectively. Self-reported frequency of poor concentration, sleep, and memory; past or current gastroesophageal reflux disease or irritable bowel syndrome diagnosis; and history of food-induced headaches were all more common in the symptomatic LBT+ group (chi square test, P < .05 for each). There were no differences in symptom frequency between asymptomatic LBT+ and LBT− samples, by any criteria, including constipation in “methane producers.” Conclusions: The frequency of SIBO positivity is highly variable depending on the interpretation criteria applied to the results. Positive LBT results are common in asymptomatic individuals, and this finding should deter routine use of LBT except for highly symptomatic patients. (2170) Effectiveness of Integrative Health-care Support on Hypertensive Patients in Japan Kiyoshi Suzuki, MD, PhD1 and Hiroshi Katamura, MD, PhD2 1MOA Health Science Institute, Tokyo, Japan 2MOA Health Science Foundation, Tokyo, Japan Abstract Purpose: To examine whether adhering to an integrative medicine approach toward normalizing blood pressure (BP) and reducing/stopping drug use is more effective than conventional medicine. Results: Of the351 subjects, 131 (37.3%) patients received medical treatment at Tokyo Ryo-in Clinic (group A), 106 (30.2%) patients received treatment at other clinics (group B), and the remaining 114 (32.5%) underwent medical examination once a year and did not receive any treatment (group C). During initial visit, group A were affected with higher severity of hypertension than did group B (P = .015). However, at the last visit, group A included less individuals with higher BP than did group B (P = .015). In group A, hypertension improved in 78.7% of the patients, and 29.8% either reduced/stopped antihypertensive drug use, and 10.7% increased/started taking medication. In group B, hypertension improved in 61.3% of the patients; however, only 1.9% were able to reduce/stop drug use, and 28.3% either increased/started taking medication (P < .001). Group C had higher number of patients with mild hypertension than any other groups during initial visit, but hypertension improved in only 19.3%, and 3 patients died before their mid-70s. Conclusions: In hypertensive patients who received integrative health-care support, approximately 30% could either reduce/stop taking medication without the risk of adverse events. However, about 30% of patients receiving treatment at other clinics increased/started drug use. Hypertension did not improve for most patients who have only undergone medical examination. (2171) Effects of Different Types of Yoga on Hypertension: A 3-Armed Randomized Controlled Trial Charlotte Sellin1, Dania Schumann, MSc1, Holger Cramer, PhD1 and Gustav Dobos, MD PhD1 1University of Duisburg-Essen, Essen, Germany Abstract Purpose: Clinical research suggests that yoga can induce short-term reductions of blood pressure in hypertensive patients. Breathing and meditation rather than physical postures seem to be the active part of yoga interventions for hypertension. This study aimed to compare the efficacy of yoga with and without physical postures for improving blood pressure in patients with hypertension. Results: A total of 75 patients (72.0% women; 58.7 ± 9.5 years) were randomized to yoga including postures (n = 25), yoga without postures (n = 25), or control (n = 25). After 12 weeks, the yoga group without postures had significantly lower 24-h systolic blood pressure compared to control (difference [Δ] = −3.8 mm; 95% confidence interval [CI] −0.3 to −7.4 mm; P = .035) as well as compared to yoga including yoga postures (Δ = −3.2 mm; 95% CI −6.3 to −0.8 mm; P = .045). After 24 weeks, the findings reversed: the yoga group including postures now had significantly lower 24-h systolic blood pressure compared to control (Δ = −5.3 mm; 95% CI −9.8 to −0.8 mm; P = .022) and to yoga without yoga postures (Δ = −4.6 mm; 95% CI −9.3 to −0.3 mm; P = .037). Comparable findings were revealed for day-time systolic blood pressure. No serious adverse events occurred in any group. Conclusions: In line with prior research, short-term effects on ambulatory blood pressure were induced by yoga based on breathing and meditation but not by yoga including physical postures. However, in order to induce longer term effects, the inclusion of yoga postures seems to be required. Yoga can be recommended as a complementary intervention for pharmacologically treated patients with hypertension. (2176) Changes in Coping and Quality of Life Among Children With Chronic Pain at an Interdisciplinary, Integrative Medicine Pediatric Pain Clinic Caitlin Neri, MD, MPH, Laura Goldstein, PsyD, Kristen Bodner, MPH, Salvatore D'Amico, BS, Kelsey Macapagal, MPH and Paula Gardiner, MD, MPH1 1Boston, Massachusetts Abstract Purpose: Chronic pain in children and adolescents often result in missed school, poor coping skills, and a decreased quality of life. Results: From 2015 to 2017, 70 participants were seen at the Pediatric Pain Clinic. Age groups include school age (30%), adolescence (54%), and young adult (16%). Seventy-nine percent of participants were female, 42% identified as White, and 27% African-American. Upon intake, 23 participants missed more than 10 days of school in the previous month due to pain (34%). For overall Integrative Medicine, 69% reported ever using; 23% reported current use at baseline; 33% reported use at 3-months. For mind–body strategies, 56% reported ever using; 16% reported current use at baseline; 30% reported used at 3-months. From baseline to follow-up, participants showed an increase in positive coping mechanisms (8%) (eg, distractions, meditation) There was no change in negative coping mechanisms. Results from the PedsQL showed an increase in emotional quality of life. Additionally, PCS showed decreases in magnification (P = .0035) and helplessness (P = .0034). Among all 24 participants who completed the 3-month follow-up, school/academics was the most frequent self-reported stressor (71% overall). In participants in the school-age and adolescence groups, social/peer issues were the second highest (53% and 36%, respectively). However, among the young adult group, parental stress was the second most reported stressor (36%). Conclusions: Overall, positive coping and emotional quality of life increased among participants and negative coping decreased. (2178) Mindfulness Meditation for Workplace Wellness: An Evidence Map Aneesa Motala, BA1, Stephanie L. Taylor, PhD, MPH2, Nell J. Marshall, PhD3, Isomi M. Miake-Lye, PhD4, Michele R Solloway, PhD1, Susann Hempel, PhD1 and Lara G. Hilton, MPH1 1RAND Corporation, Santa Monica, California 2VA Greater Los Angeles Healthcare System, Los Angeles, California 3Palo Alto, California 4West Los Angeles VA Medical Center, Los Angeles, California Abstract Purpose: Mindfulness interventions aim to foster greater attention and awareness of present moment experiences. Uptake of mindfulness programs in the workplace has grown as organizations look to support employee health, well-being, and performance. In support of evidence-based decision-making in workplace contexts, we created an evidence map summarizing physical and mental health, cognitive, affective, and interpersonal outcomes from systematic reviews of randomized controlled trials (RCTs) of mindfulness interventions. Results: In total, 168 systematic reviews met inclusion criteria. Reviews included a variety of mindfulness-based interventions including mindfulness-based stress reduction and mindfulness-based cognitive therapy. The largest reviews addressed general health effects, psychological outcomes, chronic illness, pain, and substance use. Twenty-six systematic reviews assessed studies conducted in workplace settings, health-care professionals, educators, and caregivers. The evidence map shows the research volume and highlights promising applications of mindfulness interventions. Conclusions: The evidence map provides an overview of existing mindfulness research. It shows the body of evidence to inform policy and organizational decision-making supporting employee well-being in work contexts. (2180) Appropriateness of Spinal Manipulation/Mobilization for Chronic Low Back Pain: Systematic Review Ian D Coulter, PhD1, Eric L. Hurwitz, DC, PhD2, Howard T Vernon, DC, PhD3, Cindy Crawford, BA4, Margaret D Whitley, MPH1 and Marika Booth, MS1 1RAND Corporation, Santa Monica, California 2Honolulu, Hawaii 3Canadian Memorial Chiropractic College, Toronto, Ontario, Canada 4RAND Health, Santa Monica, California Abstract Purpose: Systematic review of the scientific literature of manipulation and mobilization for the treatment of chronic low back pain. Results: A small-medium effect in favor of manipulation for chronic low back pain patients with pain duration of at least 3 months or more. The effect increased over time for reducing pain intensity. Manipulation was also shown to reduce disability. In the case of studies that defined chronic pain as 12 months or more, there is insufficient evidence to draw any conclusions. Evidence to support mobilization interventions is not as strong as the manipulation intervention studies. Conclusions: The multimodal studies programs, where the effect of either manipulation or mobilization could be “teased out,” may be the most promising style of interventions for patients’ overall benefit. (2181) Appropriateness of Spinal Manipulation/Mobilization for Chronic Cervical Pain Patients: A Systematic Review Margaret D Whitley, MPH1, Eric L Hurwitz, DC, PhD2, Marika Booth, MS1, Howard T Vernon, DC, PhD3, Cindy Crawford, BA4 and Ian D Coulter, PhD1 1RAND Corporation, Santa Monica, California 2Honolulu, Hawaii 3Canadian Memorial Chiropractic College, Toronto, Ontario, Canada 4RAND Health, Santa Monica, California Abstract Purpose: Findings from the systematic review of the scientific literature regarding the efficacy, effectiveness, and safety of manipulation and mobilization for the treatment of chronic neck pain. Results: Patients suffering the consequences of chronic neck pain for at least 12 weeks or more are likely to experience a reduction in pain intensity with manipulation compared to sham or no treatment. There were not enough data to assess the strength of the evidence for mobilization compared to sham or no treatment for reducing pain intensity or disability. Manipulation produces a much larger effect over mobilization interventions for reducing pain intensity. Conclusions: Other critical outcomes such as disability and health related quality of life need to be included in future studies in order to draw more definitive conclusions for addressing patient-reported outcomes. (2182) Clinical Observation on Treatment of Adult-attention Deficit Hyperactivity Disorder by Acupuncture Refreshing Brain Method Ta-Ya Lee, PhD, DAOM, DNP, MPH, MBA1 1Baltimore, Maryland Abstract Purpose: Systematically evaluated previous 5 years of Chinese Medicine to treat attention deficit hyperactivity disorder (ADHD) research literatures to explore the possibility and effectivity of utilizing the Xing Nao Kai Qiao (XNKQ) acupuncture technique. Based on clinical observational studies to evaluate the effectiveness of XNKQ techniques to treat adult ADHD patients, and utilized literature reviewed of functional MRI acupuncture point researches to explore the mechanism of using XNKQ technique for treating adult ADHD patients. Results: 1. Literature review (1) There were 1803 articles in total listed with these key words, and only 691 articles left within the last 5-year limitation. A totally of 76 research articles met the criteria for this literature review. There were 4 articles (5.2%) rated high quality and 59 articles (77.6%) rated good quality for research evidence, but most of articles did not fulfill the high quality of research evidence. There were 9 articles (11.8%) rated level I, 5 articles (6.5%) rated level II, 5 articles (6.5%) rated level III, 3 articles (3.9%) rated level IV, and 37 articles (48.6%) rated level strength of evidence. (2) The acupuncture treatment with ADHD prescription medication was better than ADHD prescription alone, for improved ADHD symptoms, reduced medication side effect, and showed statistical significance (P < .05). 2. Clinical research (1) The baseline data The adult ADHD self-report scale symptom checklist, Connors’ adult ADHD rating scale screening tool compared patients’ differences in gender, none ADHD medication, ADHD medication showed no statistical significance (P > .05). (2) The total effective rate Totally 34 patients completed clinical observation study with 8 XNKQ treatments. Overall, the scores of repeat measure scales indicated the decrease of ADHD symptoms. (3) The adult ADHD self-report scale symptom checklist This scale showed a statistically significant difference (P < .001) after 8 treatments, and there was a statistically significant difference between the male and female gender (P < .001). Based on the simple contrasts repeated measure analysis, adult ADHD self-report scale symptom checklist had a statistically significant difference (P < .001) after the first treatment. The third, fourth, and fifth treatment survey scores stayed in plateau, with no statistically significant significance (P = .056, P = .065, P = .004). By the sixth, seventh, and eighth treatment, the survey scores had reached the statistically significant significance (P < .001). (4) The Connors’ adult ADHD rating scale screening tool This tools results showed a statistically significant difference (P < .001) after 8 treatments. Based on the simple contrasts repeated measure analysis, Connors’ adult ADHD rating scale screening tools results had a statistically significant difference (P < .001) after the first treatment. The third and fourth treatment survey scores stayed in a quiescent period (plateau), with no statistically significant significance (P = .426, P = .030). The survey scores had reached the statistically significant significance of (P < .001) by the fifth treatment. The sixth and seventh treatment survey scores stayed in plateau, with no statistically significant significance (P = .014, P = .007). By the eighth treatment, the survey scores had reached the statistically significant significance (P < .001). Conclusions: 1. The literature study (1) Most of articles did not reach the high quality of research evidence standards. This systematic review reached level III and V strength of evidence. Most of quality of the evidence were rated good (B level). Thus, the acupuncture research needs to improve in strength and quality by improving the research methodology. (2) Acupuncture treatment may improve ADHD patient’s symptoms and compared to Western medicine prescription treatment with less side effect. 2. The clinical trials (1) This clinical observation study indicated the effective, feasibility, and safety of XNKQ techniques to treat adult ADHD patients. (2) This study will lay the foundation for the further clinical research for utilizing XNKQ technique and functional MRI, proof the advantage of XNKQ technique, and hopefully to contribute the promotion of XNKQ technique for treating adult ADHD patients. (2184) Complementary Therapies for Depression: A Systematic Review of Reviews Heidemarie Haller, MSc1, Dennis Anheyer, MA1, Gusatv Dobos, MD1 and Holger Cramer, PhD1 1University of Duisburg-Essen, Essen, Germany Abstract Purpose: Standard antidepressants were shown to be superior to placebo only for very severe symptoms of depression. Clinical depression guidelines, however, still do not systematically search for alternatives and vary widely in their recommendations of complementary (CAM) therapies. This systematic review therefore aimed at summarizing the recent level-1 evidence of CAM in patients with primary depression. Results: Literature search revealed 24 meta-analyses conducted between 2003 and 2017 on 2 to 29 randomized controlled trials (RCTs) in patients with major, minor, and seasonal depression. The quality of RCTs and meta-analyses ranged between low to high. Based on consistent high-quality evidence, grade A recommendations can be given for St. John’s wort as it was superior to placebo and a safer equivalent to standard antidepressants for mild to moderate major depression. Moderate-quality evidence resulted in grade B recommendations for saffron and mindfulness-based cognitive therapy as well as bright light, dance and music therapy as adjunctive treatments, and acupuncture for treating drug side effects. Grade D recommendations were given for mindfulness-based stress reduction, spiritual-adapted cognitive therapy, selected supplements, and yoga showing several promising effects, however, across low-quality studies. Conclusions: CAM treatments can be recommended with different grades for treating depression. Quality of further research needs improvement. (2190) Effects of a Delphi Consensus Acupuncture Treatment Protocol on the Levels of Stress and Vascular Tone in Women Undergoing In Vitro Fertilization: A Randomized Clinical Pilot Study Preliminary Findings Yan Zhang, PhD1, Jennifer Phy, DO1, Jennie Orlando, MD1, Sheila Garos, PhD2, Lindsay Penrose, PhD1, Samuel Prien, PhD1 and Jaou Chen Huang, MD1 1Lubbock, Texas 2Texas Tech University, Lubbock, Texas Abstract Purpose: In 2012, a Delphi consensus protocol is published to describe the parameters of best acupuncture practice for assisted reproductive technology and future research. However, there has been no clinical trial utilizing this protocol to assess its effects. Our pilot study aimed to assess the feasibility of the Delphi consensus acupuncture protocol and examine the impact of acupuncture on stress and tissue perfusion. Results: By the time of the preliminary analysis, 37 who completed the study and had all 6 time points of urine collection were included in the analytic sample (20 and 17 in the acupuncture group and the control group respectively). A paired t test comparing changes of visit 1 to visit 3 showed that stress score reduction in both acupuncture (0.21 ± 0.43, P = .039) and control (0.04 ± 0.34, P = .678) groups. No significant changes of ratios of 6-k-PGF1α to TxB2 were found. Power analysis indicated that the current results are underpowered. Conclusions: A Delphi consensus acupuncture treatment protocol is feasible and safe to be carried out in a reproductive clinical setting. Acupuncture may affect the self-perceived stress levels in women undergoing in vitro fertilization (IVF). Bigger sample size is warranted in future study to further assess the impact of acupuncture on individuals receiving IVF treatment. (2192) A Cross-sectional Review of the Prevalence of Integrative Medicine in Pediatric Pain Clinics Across the United States Paula Gardiner, MD, MPH1, Kelsey Macapagal, MPH1, Salvatore D'Amico, BS1, Laura Goldstein, PsyD1, Caitlin Neri, MD, MPH1 and Kristen Bodner, MPH1 1Boston, Massachusetts Abstract Purpose: This project assesses the prevalence of integrative medicine (IM) in pediatric pain clinics (PPCs) across the United States. Results: Of the 53 PPCs identified, 43 (81%) were part of a nonprofit health-care organization, and 10 (19%) were within a private hospital; 85% were located in urban settings, 15% in rural settings; 83% were located in free-standing children’s hospitals. Thirty-two (60%) PPCs utilized IM, including acupuncture (38%), mind–body (21%), massage (21%), aromatherapy (19%), nutrition counseling (17%), and/or art/music therapy (11%). The most prevalent providers within PPCs offering IM were yoga instructors (84%), nutritionists (56%), and mind–body specialists (44%). IM was offered in 63% of programs in nonprofit organizations and 50% in private hospitals; 58% of urban sites and 75% of rural sites. Thirty-one percent of PPCs with IM were located in the Midwest, 29% in the West, 25% in the Northeast, and 15% in the South. Conclusions: Of 53 current PPCs, over half offer IM services. However, children in southern regions or by private hospitals have less access to IM than children in other regions of the United States. (2194) Showcase of Collaboration Between Integrative Medicine and Interprofessional Education Yan Zhang, PhD Renée J Bogschutz, PhD1 and Betsy Jones, EdD2 1Lubbock, Texas 2Texas Tech University Health Sciences Center, Lubbock, Texas Abstract Overview: Background: A biennial Integrative Medicine Symposium (IMS) was developed at an academic health sciences center to increase awareness of integrative medicine via interprofessional education (IPE) learning activities. The purpose of this poster presentation is to describe this integrative medicine IPE activity, provide lessons learned from the most recent symposium, and share participant outcomes data. Program Description: The 2017 theme of the IMS was Mind–Body Wellness: the Science, Art and Practice. This symposium included 2 keynote speakers, an interprofessional panel discussion, a therapeutic tea brewing station, an aroma essence mixing station, a wellness art exhibit, and 10 interprofessional hands-on complementary medicine workshops. These included acupuncture, dry needling, reflexology, taping, reiki, mindfulness, therapy dogs, music therapy, performing arts, and yoga. Each workshop was designed to give participants across multiple health professions a better understanding of the professional roles and responsibilities related to each presented modality. Results: According to the assessment data, the majority of the participants agreed or strongly agreed that the content of the symposium was relevant, informative, and/or educational (97%) and that it emphasized the importance of collaborative care and teamwork (92%). As for the workshops, nearly all of participants indicated that the workshops provided a hands-on, collaborative, and active-learning environment (100%) and allowed them to learn with, about, and from each other (95%). Lessons learned regarding planning, logistics, interprofessional education integration strategies, assessment methods, and marketing approaches will be shared in the presentation. Conclusion: To improve patient-centered care and overall patient health, it is critical for health-care practitioners to be informed about integrative medicine modalities and have opportunities to learn, from, with, and about other health-care professionals. An engaging, interprofessional IMS is an efficacious approach to providing interprofessional participants with evidence-based treatment options within a collaborative team-based environment. Rationale: Overall, integrative medicine reaffirms the importance of the relationship between practitioner and patient and makes use of all appropriate health-care professionals and disciplines to achieve optimal health and healing. Therefore, it is important to train and involve health-care practitioners from multiple professions/disciplines to provide patient-centered integrative care. This poster highlights the experience of developing an IMS as an IPE learning activity across different health-care professions, which fits perfectly with the theme of the congress “Collaboration in Action: Advancing Integrative Health through Research, Education, Clinical Practice and Policy.” Objectives: As result of this poster presentation, the participants will be able to describe the importance of integrating IPE and collaborative care concepts into integrative medicine information for health-care practitioners; list 3 ways to provide hands-on IPE learning experiences related to integrative medicine treatment modalities to foster a collaborative and active-learning environment; and relate 3 lessons learning when developing an engaging, interprofessional IMS. (2197) Differing Definitions of Chronic Pain: Comparison of Patients, Providers, and Researchers Ian D Coulter, PhD1, Gery Ryan, PhD1, Margaret D Whitley, MPH1 and Lara G Hilton, MPH1 1RAND Corporation, Santa Monica, California Abstract Purpose: Patient perspectives on what constitutes chronic pain are less understood than clinician and research definitions. We explored the relationships between these 3 perspectives on chronic low back and neck pain in order to inform health policy. This study is nested within a National Center for Complementary and Integrative Health Center of Excellence for Research on Complementary and Alternative Medicine. Results: Findings indicate that patient definitions are misaligned with research and clinician definitions; however, research and clinical definitions overlap somewhat. Clinical and research definitions emphasize duration, while patient definitions emphasize permanency of the condition, quality of life, and function. Conclusions: Patient attitudes about pain are important, as they impact care seeking behaviors and expectations for outcomes. Findings are key for future research on chronic pain within the context of patient-centered care that emphasizes the provision of care that is respectful of and responsive to individual patient preferences, needs, and values. (2198) The Role of Personality in Patients With Fibromyalgia Chenchen Wang, MD, MSc1, Raveendhara R Bannuru, MD, PhD1, Andrew Seto, BA1, William F Harvey, MD, MSc1, Teresa Wu, BA1, Xingyi Han, MPH1 and Lori L Price, MAS, MLA2 1Tufts Medical Center, Boston, Massachusetts 2Tufts University, Boston, Massachusetts Abstract Purpose: Previous studies investigating potential associations between personality and clinical symptoms in fibromyalgia patients have found mixed results. We examined the associations between personality dimensions and overall fibromyalgia impact, psychosocial factors, and health-related outcomes in fibromyalgia patients. Results: The sample consisted of 92 participants (95% female, mean age = 52, body mass index 30 kg/m2, 52% white, 94% with high school degree, mean duration of body pain of 14 years). Multivariable linear regression showed neuroticism was significantly associated with Revised Fibromyalgia Impact Questionnaire and symptom severity (Table 1). Higher neuroticism was also associated with higher anxiety, depression, and stress, worse mental quality of life, and lower self-efficacy, mindfulness, and social support. Higher conscientiousness and extraversion were associated with better mental quality of life and mindfulness, and lower symptom severity, anxiety, depression, and stress. Higher conscientiousness was associated with better self-efficacy and outcome expectations. Higher extraversion was associated with better social support. More openness was associated with better outcome expectations, mindfulness, and less depression. Agreeableness was not associated with any outcome. Conclusions: Personality was associated with fibromyalgia impact and a variety of health outcomes. Higher neuroticism was associated with worse psychosocial factors, suggesting this subset of patients may benefit from treatment that takes personality into consideration. Results further elucidate characteristics of fibromyalgia patients. (2199) Expansion of Integrative Medicine Services Within an Interdisciplinary Pediatric Pain Clinic in an Urban Safety Hospital Salvatore D'Amico, BS1, Pei-Chi Kao, MPH1, Kristen Bodner, MPH1, Caitlin Neri, MD, MPH1, Laura Goldstein, PsyD1, Kelsey Macapagal, MPH1 and Paula Gardiner, MD, MPH1 1Boston, Massachusetts Abstract Purpose/Background: Chronic pain is a growing problem among children and adolescents and is more prevalent in children from low income families. In 2015, the Boston Medical Center Interdisciplinary Pain Clinic launched an Integrative Medicine (IM) team model to address chronic pain in children. Types of IM services include acupuncture, massage, aromatherapy, nutrition, and therapeutic karate. Children are referred to pain clinic from primary care and specialty providers. During initial consultation, the clinical team discusses which IM therapies are appropriate for the patient. The patient is scheduled for follow-up visits with the IM adjunctive services. Results: Seventy-five participants were enrolled from June 2016 to September 2017. Demographics include average age of 14.75 years; 27% identified as Black, and 27% identified as Latino. For primary pain regions, 40 (53%) participants reported chronic abdominal pain, 17 (23%) reported chronic migraines/headaches, and 13 (17%) reported musculoskeletal pain. Fifty (67%) participants had problems falling or staying asleep, and 46 (61%) reported missing 5 or more days of school in the past year due to pain. At baseline, 28 patients (37%) reported having previous experiences using IM, including dietary supplements (56%), massage (16%), and acupuncture (12%). Among patients who attended the pain clinic, 73 (97%) were recommended acupuncture, 71 (95%) were recommended aromatherapy, and 66 (88%) were recommended massage. Conclusions/Discussion: IM services including acupuncture, aromatherapy, and massage are acceptable to children who attend a pediatric specialty pain clinic in an urban safety-net hospital. For the majority of patients, this is their first experience with IM. (2202) Involvement of Salience Network in the Expectations of Sensory Experience for Acupuncture Stimulation Younbyoung Chae, PhD1 1Kyung Hee University, Seoul, Republic of Korea Abstract Purpose: The brain is known to actively interpret sensory inputs from the integration of top-down and bottom-up information. Humans can make inferences on somatosenation based on prior experiences and expectations even without the actual stimulation. We used functional MRI and investigated the neural substrates to the expectations of sensory experience about acupuncture stimulation without invasive cutaneous stimuli. Results: Expectations of acupuncture stimuli without actual stimulation on 3 acupoints resulted in greater deqi sensation compared to the control condition. Cognitive components of acupuncture stimulation exhibited greater brain activation in the anterior insula, dorsal midcingulate cortex and presupplementary motor area, and secondary somatosensory area. Conclusions: We demonstrated that expectations of acupuncture stimulation exhibited a distinct experience of somatosenation as well as activations in salience networks in the brain. Our findings imply the involvement of salience network in cognitively induced somatosensation from acupuncture stimulation, which is likely due to the predictive role of salience network in monitoring internal and external bodily state. (2207) Efficacy of Clinic-based Treadmill Walking in Creating Behavioral Change in Overweight and Obese Adults With Bipolar I Disorder Jacob Poynter, BS1, Allesandro Cuomo, MD2, Suzanne Havstad, MS3, Anne Germain, PhD4, Andrea Fagiolini, MD5, Ellen Frank, PhD4, David J Kupfer, MD4 and Carol Janney, PhD6 1Michigan State College of Human Medicine, Livonia, Michigan 2University of Siena School of Medicine, Siena, Italy 3Henry Ford Health System, Livonia, Michigan 4University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 5University of Siena School of Medicine, Siena, Italy 6Michigan State College of Human Medicine, Midland, Michigan Abstract Purpose: To determine the efficacy of in-clinic treadmill walking as part of a weekly behavioral intervention program among overweight and obese adults with bipolar I disorder (BD). Results: Optional clinic treadmill walking was offered to 37 of 50 (74%) IRRI participants and 54%(n = 20) expressed interest. At baseline, participants averaged 5075 ± 2128 total steps/day. On average, participants walked on the treadmill for 29 ± 9 min, 1.4 ± 0.5 miles, 3 mph, 8 ± 6 (62%) of sessions. Treadmill walkers (n = 16) increased PA by an average of 857 steps/day (P = .11) and 5690 aerobic steps/week (P = .04) from baseline to 4-month follow-up (end of weekly in-clinic treadmill walking sessions). At 6-month follow-up, in-clinic treadmill walkers averaged 293 more steps/week (P = .62) and nontreadmill walkers averaged 137 less steps/week (n = 17, P = .83) when compared to baseline. Conclusions: Weekly in-clinic treadmill walking with a lifestyle coach facilitates PA in adults with BD. It remains to be established whether lack of sustained behavioral change at 6 months was due to inadequate program length or lack of access to exercise facility/equipment. (2208) Integration of Transcendental Meditation® Into Alcohol Use Disorder Treatment Jan Gryczynski, PhD1, Robert P Schwartz, MD1, Marc J Fishman, MD2, Courtney D Nordeck, BA1, James Grant, EdD3, Sandi Nidich, EdD4, Stuart Rothenberg, MD4 and Kevin E O'Grady, PhD5 1Friends Research Institute, Baltimore, Maryland 2Maryland Treatment Centers, Baltimore, Maryland 3Maharishi Foundation USA, Fairfield, Iowa 4Maharishi University of Management, Fairfield, Iowa 5College Park, Maryland Abstract Purpose: Maladaptive responses to stress are thought to play a role in addiction and relapse. Transcendental Meditation (TM) is a popular meditation technique with promising clinical applications. This study sought to (a) examine the feasibility of providing TM during alcohol use disorder (AUD) treatment, (b) compare outcomes for TM versus treatment as usual (TAU), and (c) investigate the relationship between TM practice and outcomes. Results: Integrating TM into inpatient AUD treatment was feasible. Uptake of TM was high (85% meditating on most of the past 30 days at follow-up; 61% closely adherent to recommended practice of twice-daily TM). Participants reported high satisfaction with TM. The sample as a whole improved on multiple measures after AUD treatment, but there were no significant differences between TM and TAU cohorts. However, those practicing TM twice daily as recommended were less likely than the rest of the sample to return to any drinking (25% vs 59%; P = .02) or heavy drinking postdischarge (0% vs 47%, P < .001). Greater regularity of TM practice was inversely correlated with stress, psychological distress, craving, and alcohol use at follow-up. Conclusions: This study established the feasibility and acceptability of using TM during AUD treatment. Consistently practicing TM (but not just learning it) was associated with better outcomes. These promising findings warrant further investigation in larger, controlled studies. (2212) Interprofessional Collaboration Among Integrative Health and Medicine Providers in Private Practice and Community Health Settings Providing Care to the Underserved Beth Rosenthal, MPH, MBA, PhD1, Anthony Lisi, DC2 and Hannah Gravrand, DC, MS3 1Academic Collaborative for Integrative Health, Chicago, Illinois 2University of Bridgeport, Bridgeport, Connecticut 3VA Sierra Nevada Health Care System, Reno, Nevada Abstract Purpose: To investigate the extent and features of interprofessional collaboration (IPC) among integrative health and medicine (IHM) providers from the 5 licensed disciplines and to explore IPC and other characteristics of IHM providers who are providing care to medically underserved patients either in private practice settings or at community health centers (CHCs). Results: We conducted interviews with 12 providers in private practice and 14 providers in CHCs. The outcomes our presentation focuses on are the perceived impacts of IPC and recommendations to improve IPC. Conclusions: We found that most subjects had little to no exposure to IPE during their training, yet emphasized the importance of IPE for current/future students in their profession. Most subjects reported having/finding time to communicate and meet other providers is of importance to IPC. Most subjects reported that IPC has a strong positive impact on patient care and professional satisfaction. (2214) A Bibliometric Analysis of Clinical Study Literatures of Traditional Chinese Medicine Therapies for Smoking Cessation Jian-Hua Wang, PhD1, Mei Wang, PhD1, Shu-Chun Liu, PhD1, Xiao-Feng Du1, Mei Han, PhD2, Jun-Feng Liu, PhD1, Wei Qin, PhD1, Bin Chen, PhD1, Robbert van Haselen, PhD3 and JianPing Liu, PhD4 1Liaoning University of Traditional Chinese Medicine, Shenyang, China 2Beijing University of Traditional Chinese Medicine, Beijing, China 3International Forum on Integrative Medicine, France 4Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: This study aims to systematically retrieve and analyze the literatures related to smoking cessation using Traditional Chinese Medicine (TCM) therapies in order to understand the current situation and provide reference for further evaluation of TCM therapies for smoking cessation. Results: In total, 260 literatures were identified from 1980 to 2016, including 17 systematic reviews, 52 randomized clinical trials, 7 controlled clinical studies, 110 case series, 18 case reports, 1 cohort study, 50 traditional reviews, and 5 descriptive epidemiological studies. The majority (178; 68.5%) were published in Chinese. The annual number of publications increased slightly in wavy linear, with a peak of 14 in 2006. China (129; 49.6%) was the leading country in conducting studies in this field, followed by the United States (27; 10.4%) and UK (25; 9.6%). From 40 countries, 36,645 participants with age ranging from 12 to 86 years were involved in 188 clinical studies (excluding reviews and epidemiological studies). The most commonly reported therapy was auricular acupressure (25; 13.3%), followed by body acupuncture (14; 7.4%), and body acupuncture plus auricular acupressure (14; 7.4%). Composite outcomes (combination of withdrawal rate, withdrawal symptoms, smoking craving, and other indicators referring to smoking cessation) was the most frequently reported outcomes (110; 58.5%). Conclusions: A substantial number of clinical studies have been conducted on TCM therapies during the past 3 decades. Further systematic reviews should take place to comprehensively assess the evidence on TCM therapies for smoking cessation in order to formulate effective and feasible smoking cessation measures in combination with the actual situation of smokers. (2216) Nutraceutical Approach to Treating Subclinical Hypothyroidism Amy Locke, MD1 and Briana M Rueda, DO1 1Salt Lake City, Utah Abstract Overview: Subclinical hypothyroidism is a common disorder with controversial treatments. Several studies have shown that patients with subclinical hypothyroidism suffer from many of the same cardiometabolic and psychophysiologic effects as overt hypothyroidism. These include dyslipidemia, insulin resistance, nonalcoholic fatty liver disease, increased carotid artery intima thickness, cerebral small vessel disease, and decreased quality of life. However, due to the suppressive effects of replacement and the potential need for lifelong treatment, many health-care providers are hesitant to initiate hormone replacement. Here, the latest in scientific research is applied to highlight an integrative medicine approach to treating subclinical hypothyroidism using nutraceutical therapies, including supplementation with selenium, vitamin D, Ashwagandha, myo-inositol, and optimization of iodine levels. This approach can result in the normalization of thyroid function without the suppressive effects of hormone replacement. Rationale: Relevant to this year’s conference theme, subclinical hypothyroidism is a condition that is treated by a wide variety of integrative medicine providers. Within the integrative medicine community, collaboration and agreement as to an optimal treatment of subclinical hypothyroidism is much needed. It is also relevant from a scientific standpoint, as the number of studies regarding nonpharmacologic treatment of subclinical hypothyroidism is rapidly expanding. With an ever-increasing amount of knowledge available, it is imperative to determine which therapies have been clinically proven successful and should be implemented as valid treatment options for integrative medicine providers. Objectives: Following this presentation, participants will be able to identify which patients would most benefit from a trial of nutraceutical therapies prior to hormone replacement, identify the risks and benefits of a nutraceutical approach to subclinical hypothyroidism, and have a solid understanding of the latest scientific evidence demonstrating statistically significant improvements in thyroid-related biomarkers in patients with subclinical hypothyroidism using a nutraceutical-based integrative medicine treatment approach. (2217) Guided Imagery for Anxiety Reduction for Nursing Students Damaris m Grossmann, RN, DNPc1 and Molly Bradshaw, DNP, APRN, FNP-BC, WHN-BC1 1Newark, New Jersey Abstract Purpose: In this section, the aim is presented with corresponding objectives. The overarching aim of this project is to investigate guided imagery as a tool to for anxiety reduction in graduate nursing students. Ultimately, guided imagery intervention will be incorporated for future use self-care and many health settings for utilization in patient care. Results: This study still in process. Results to be determined by January 2018 Conclusions: Tentative conclusion: Guided imagery is a reliable tool to reduce anxiety in graduate nursing students, which has the potential for sustainability and replication in the future. One-way guided imagery can be utilized to reduce anxiety would be to purchase and hand out the guided imagery information cards with guided imagery resources to students to use when needed. Guided imagery could also be replicated for use in future semesters within the university. The prerecorded media of guided imagery may be utilized prior to examinations and with additional student cohorts, including the undergraduate students. The university could purchase the guided imagery for the students to use prior to their examination or for any time needed. Overall, this project of guided imagery intervention as an effective solution for reducing anxiety in nursing students and further projects would be beneficial to implement with use of control subjects and evaluation of physiological changes within the body with use of application of guided imagery. Additionally, the use of guided imagery intervention would be affordable, safe and sustainable for use by any nurse or health-care professional in any health-care setting for improvement of patient-centered care. (2220) An Event-related Potential Study on Cognitive Regulation Mechanism in Subthreshold Depression: The Happier, the Better? Yichunzi Zhang1, Xue Li1, Junhui Kong1, Jinpeng Zhang1, Xi Tan1 and Lesley Zhang1 1Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: In the perspective of preventive treatment of disease, the theory of mutual restraints of emotions of Traditional Chinese Medicine (TCM) can help to improve the emotional state of subthreshold depressive people. The paper aims to find out the mechanism of delight regulating cognition of subthreshold depressive people. Results: After delight induction, delight score of visual analogue scales of group 2 (delight-induction group of the subthreshold depressive) was increased (M = 40.29 vs M = 69.32), and anxieties score of visual analogue scales of group 2 was decreased (M = 34.68 vs M = 20.03). The amplitudes of N2 of group 2 were higher than group 4 (control group of the subthreshold depressive; positive stimulation: t = −2.10, P < .05; neutral stimulation: t = −3.65, P < .001; negative stimulation: t = −1.98, P < .05), and under positive stimulation, the amplitude of P3 of group 2 was higher than group 4 (t = −3.51, P < .001), and under neutral stimulation, the latency of P3 of group 2 was shorter than group4 (t = −4.42, P < .000) and the normal (subjects in group 1 and group 3; t = −3.41, P < .001). Conclusions: Delight can improve the emotional state of the subthreshold depressive. For the subthreshold depressive, delight induction enhanced their cognitive control ability and their attention processing ability of positive stimulation and greatly improved their cognitive processing ability of neutral stimulation. (2224) Changing Workforce Dynamics: The Experience of Integrative Professionals Working Within Patient-centered Medical Homes Jennifer Olejownik, PhD1 1 Academic Collaborative for Integrative Health, Columbus, Ohio Abstract Purpose: Given the context of the changing health-care landscape, integrative professions can help reduce health care costs and improve the patient experience. The Patient-centered Medical Home (PCMH) movement is a comprehensive, team-based approach to care that focuses on quality, accessibility, and coordinated services. While physicians are typically the first point of contact in this model, other integrative professionals are exploring leadership roles in PCMHs. This research will explore some of the challenges and obstacles integrative professionals encounter delivering care in PCMHs. Results: Preliminary findings point to common themes related to educational preparedness, the management of chronic care, the role of patient education in regard to becoming actively engaged in the healing process, the challenge of promoting a new culture centered on wellness in a system that traditionally has focused on disease, and how to best manage and treat an of influx of patients who have not had access to care for many years. Conclusions: Integrative professionals can be successful leaders within the PCMH model. Institutes of higher education could improve program offerings to better train and prepare integrative professionals, such as naturopathic physicians and chiropractors, to serve in primary care roles. Through the creation of mentoring relationships, residencies, and internship programs, other pathways could then be forged and developed for integrative professionals to acquire the skills needed to work in these settings. (2228) Integrative Oncology in Australia: Findings From a National Survey of Cancer Services and the Experiences of Cancer Survivors Jennifer Hunter, PhD, MScPH, BMed1, Caroline Smith, PhD1, Jane Ussher, PhD, BA1, Geoff Delaney, MD, PhD, MBBS2, Eleanor Oyston, BT3, Kate Templeman, PhD1, Suzanne Grant, PhD, MPS, BAppSc, BA1, Andrew Kellet, BA1 and Chloe Parton, PhD, BA1 1Western Sydney University, Sydney, Australia 2South Western Sydney Local Health District, Sydney, Australia 3Oncology Massage Limited, Canberra, Australia Abstract Purpose: The aim of this project was to examine integrative oncology (IO) service provision and unmet needs in Australia and explore cancer survivors’ views on integrating traditional and complementary medicine (T&CM) into cancer services. Results: Of the 295 eligible organisations, 275 (93%) responded; from which 71 (26%) provided IO services for a median duration of 6 years and in a variety of settings— inpatient (52%), outpatient (53%), dedicated centre (35%) and home visits (4%). Compared to non-IO providers, organisations were more likely to be owned by a not-for-profit company (46%) or were government owned (38%) (P < .001). Provision was restricted at most sites to a limited range of services, most commonly massage (73%), well-being (71%) and movement modalities (39%). Institutional policies and information regarding CM products and practitioner services were generally underdeveloped and inconsistent for IO and non-IO providers alike. Thematic and content analysis of the cancer survivor data (n = 154) identified the need for greater service provision and more equitable access to IO services. There was a substantial mismatch between cancer services’ provision of and cancer survivors’ use and demand for biologically based T&CM therapies and advice. Conclusions: Australian health-care organisations are increasingly providing IO services, signalling the need for clearer national guidance and polices. Fragmented service development has led to inconsistent service provision and unmet needs across many areas of Australia. Discrepancies exist between what cancer survivors are doing or seeking, and the IO services they can access through their local cancer services. (2229) Supportive Care and Integrative Oncology: Barriers and Unmet Needs Chloe Parton, PhD, BA1, Andrew Kellet, BA1, Suzanne Grant, PhD, MPS, BAppSc, BA1, Kate Templeman, PhD1, Geoff Delaney, MD, PhD, MBBS2, Eleanor Oyston, BT3, Caroline Smith, PhD1, Jennifer Hunter, PhD, MScPH, BMed1 and Jane Ussher, PhD, BA1 1Western Sydney University, Sydney, Australia 2South Western Sydney Local Health District, Sydney, Australia 3Oncology Massage Limited, Canberra, Australia Abstract Purpose: The aim of this study was to identify unmet cancer service needs and explore barriers and solutions to integrative oncology (IO) service provision in Australia. Results: Of the 275 organisations that answered the survey, 209 (76%) provided some type of supportive cancer services and 71 (26%) provided IO. Four interrelated themes (finance, logistics, evidence and culture) were identified as barriers to providing or accessing IO. The strongest convergence across all the data was financial barriers. Out-of-pocket costs were an important barrier for 82% of cancer survivors and the only obstacle for 40%. Funding IO was the greatest barrier identified by 60% of non-IO providers. IO providers relied heavily upon patient payments, followed by philanthropy, and volunteer practitioners. Views on solutions were more contentious. Some considered it was the patient’s responsibility. Others thought the public health sector should reduce socio-economic inequalities or that higher rebates from private health insurers were required. Cancer survivors emphasised that IO was not a ‘luxury item’, rather it was important for managing side effects, comorbidity and rehabilitation. Other important barriers were general lack of IO services across much of Australia, difficulties in referral pathways, health-care professional attitudes, insufficient evidence and provider uncertainty around which IO services to provide, clinical governance and business models. Conclusions: We propose a patient-centred model with broad applicability that illustrates the complex interrelationship between patients, health-care practitioners, services and policy and the thematic barriers and solutions identified by this study. (2243) Development and Validation of an Instrument to Evaluate Inpatient Beliefs, Expectations, and Attitudes Toward Reflexology-16: A Pilot Study Samuel Attias, MPH1, Elad Schiff, MD1, Zahi Arnon, PhD2, Yael Keshet3, 4, Ibrahim Matter1, Lital Keinan Boker5, 6 and Eran Ben-Arye7 1Bnai Zion Medical Center, Haifa, Israel 2Bnai Zion Medical Center, Yezreel Valley Academic College, Haifa, Israel 3Western Galilee Academic College, Acre, Israel 4Tivon, Israel 5University of Haifa, Israel 6ICDC, Ministry of Health Israel, Tel Aviv, Israel 7Lin Medical Center, Clalit Health Services, Haifa, Israel Abstract Purpose: Despite the extensive use of manual therapies, reflexology in particular, no validated tools have been developed to evaluate patients’ beliefs, attitudes and expectations regarding reflexology. Such tools, however, are essential to improve the results of the reflexology treatment by better adjusting it to the patients’ attitudes and expectations. The tool also enables assessing correlations with clinical results of interventional studies using reflexology. Results: After its construction, the Inpatient Beliefs, Expectations, and Attitudes Toward Reflexology (IBEAR) questionnaire passed the expert group’s preliminary consensus, evaluation of the questions’ clarity (from 5.1 to 7.0), inner validation (from 5.5 to 7), and structural validation (from 5.5 to 6.75). Factor analysis pointed to 2 content worlds in a division into 4 questions discussing attitudes and expectations versus 5 questions on belief and attitudes. Of the 221 questionnaires collected, a Cronbach’s alpha coefficient was calculated on 9 questions relating to beliefs, expectations, and attitudes regarding reflexology. This measure stood at 0.716 (satisfactory reliability). At the test–retest stage, 199 research participants filled in the questionnaire a second time. The Pearson coefficient for all questions ranged between 0.73 and 0.94 (good to excellent reliability). As for dichotomic answers, Kappa scores ranged between 0.66 and 1.0 (mediocre to high). One of the questions was removed from the IBEAR following questionnaire validation. Conclusions: The present study provides evidence that the proposed IBEAR-16 questionnaire is a valid and reliable tool for the characterization of potential reflexology patients and may be effectively used in settings which include the evaluation of inpatients’ beliefs, expectations, and attitudes toward reflexology. (2244) Citation and Relevant Factors of Randomized Controlled Trials on Acupuncture Published in English Literature Liqiong Wang, PhD1, Ning Liang, MD1, Lianhan Shang, MD1, Xuehan Liu, MD1, Jianping Liu, PRO1, Chunxiang Su, PRO1 and Yu-tong Fei, MD, PhD1 1Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: Increasing number of randomized clinical trials (RCTs) have been published internationally to assess the effect and safety of acupuncture. There is insufficient information about the citation of the published RCTs to reflect their uptaking. We aim to explore the citation of acupuncture RCTs published in English and relevant factors to promote their value. Results: Eight hundred twenty-three acupuncture RCTs were identified (including 244 highly and 579 lowly cited trials of which 32 [5%] was not cited). The median of citation per year of 823 RCTs was 1.71 (interquartile range: 0.86-3.18; range: 0–27.20). Ten of the 24 variables were analyzed: diseases, center numbers was not associated with citation, but the country from the West (vs Eastern odds ratio [OR]:1.78), general and professional medical journals (vs complementary related journals OR: 2.11; 2.55), trials with multiple arms (vs 2 arms OR: 2.04), outcome specified (vs unspecified OR: 2.02), funding (vs no funding OR: 1.74), and positive results (vs negative OR: 1.73) were independently associated with more citations, while no blinding of participants were less likely to be cited (vs blinding OR: 0.60). Conclusions: Trials from the West, published in high-impact journals, with funding and positive results were more likely to be cited, and participants unblinded were less likely cited. Future acupuncture trials might be taking care of participants blinding, specified outcomes to increase their use. (2248) The Effect of Reflexology on Anxiety and Duration of the Active Phase in Primigravida Women: Preliminary Results Tamar S Lavee1, Ofri Avneri1, Dan Steinberger1, Gil Cohen, MD1, Shlomi Shosh Belachsan, BA, RN1, Samuel Sagi, MD1, Elad Attias, MPH1 and Schiff, MD1 1Bnai Zion Medical Center, Haifa, Israel Abstract Purpose: Intrapartum anxiety is a common condition associated with a negative experience, increased morbidity, and prolonged labor. The aim of this study was to assess the hypothesis that reflexology treatment can reduce anxiety of primiparous women during labor and furthermore reduce the duration of labor. Results: In the reflexology + ST group, reduction in anxiety from baseline was statistically significant (from 6.79 to 4.34, n = 32, P < .0001). Patients with baseline moderate–severe anxiety also had statistically significant reduction in anxiety (from 7.55 to 4.92, n = 28, P < .0001). In the ST group, anxiety was reduced nonsignificantly (from 5.30 to 4.90, n = 53, P = .25), however, for patients with baseline moderate–severe anxiety, there was a significant reduction (from 8 to 7.03, n = 33, P = .03). The duration of active labor from 4 to 5 cm to complete dilation of the cervix was nonsignificantly reduced in the reflexology group compared to the standard care alone group (5:31 h in the ST group [n = 28] and 5:17 h in the reflexology group [n = 58, P = .68]). The duration of labor until delivery (first + second stages) does not indicate any difference between the reflexology and the ST group, 6:27 h in the ST group (n = 28) and 6:32 h in the reflexology group (n = 58, P = .96). Conclusions: The integration of reflexology treatment with standard care is better than standard care alone in reducing intrapartum anxiety. The effect of reflexology was prominent in patients experiencing moderate to severe baseline anxiety. Duration of labor was not affected by reflexology. Future studies should utilize explanatory methodologies in order to assess the specific effects of reflexology as compared to nonspecific touch and attention. The association between expectations and outcomes should further be explored. (2251) Effects of Protein Supplementation on Energy and Protein Intake: Preliminary Findings From a Randomized, Controlled Trial in the Intensive Care Unit Monica C Serra, PhD1, Avelino C Verceles, MD1, Elizabeth A Parker, PhD, RD2 and Termeh Feinberg, PhD, MPH3 1Baltimore, Maryland 2University of Maryland School of Medicine, Baltimore, Maryland 3Center for Integrative Medicine, Baltimore, Maryland Abstract Purpose: Delivering nutrition support early in intensive care unit (ICU) stay favorably impacts patient outcomes; yet, few patients meet the American Society for Parenteral and Enteral Nutrition guidelines of ≥80% goal energy and protein (Pro) while in the ICU. Difficulty feeding is further compounded by the effects of aging including the individual’s nutritional status and number of comorbidities. Results: At baseline, there were no differences in mean energy (Health Protection and Research Organisation [HPRO]: 22 ± 4 kcal/kg actual body weight [ABW]; CON: 21 ± 4 kcal/kg ABW) or Pro (HPRO: 1.4 ± 0.2 g/kg ABW; CON: 1.3 ± 0.2 g/kg ABW) prescribed by the RD. In the first 5 days, HPRO received higher mean daily energy (1516 vs 1092 kcals, P < .01) and Pro (103 vs 57 g, P < .001) compared to CON. This effect remained significant after accounting for ABW (energy: 18.4 ± 6.0 vs 13.3 ± 6.2 kcal/kg, P = .01; Pro: 1.3 ± 0.4 vs 0.8 ± 0.4 g/kg, P < .001). The HPRO group had significantly higher adherence to RD recommendations for energy (83 ± 0.2 vs 63 ± 0.3%, P < .05) and Pro (92 ± 0.3 vs 54 ± 0.03%, P < .001). Common conditions that limited intake included holding enteral feeds in preparation for extubation, need for noninvasive ventilation, and diagnostic procedures requiring fasting and/or transport from the ICU. Conclusions: Increasing goal Pro recommendations and using whey Pro supplementation significantly increased overall energy and Pro intake in MV critically ill patients in the ICU over the first 5 days. Studies have demonstrated improved clinical outcomes following higher nutrition delivery early in ICU stay; thus, strategies to optimally reach nutrition goals to overcome feeding barriers in the ICU are needed. (2262) Ketogenic Diet for Dog With Pituitary Tumor Jacquelyne Motta, DVM1 1Vila Velha University UVV-ES Brazil, Plantation, Florida Abstract Overview: Zahn, an 8-year-old male French Bulldog with severe symptoms of vertigo, nerve paralysis and corneal ulcers caused due to a pituitary tumor was submitted on a ketogenic diet. After 6 months of therapy, the tumor-associated inflammation was completely reduced, and no more neurological deficits were found during clinical tests. On summer of 2016, after complete clinical examinations which suggested neurological deficits, the dog was submitted to image exams and blood work. Ultrasound images showed abnormalities on spleen (hypoechoic spot sizing 0.83 × 0.72 cm), liver (discreet increase in size and volume), and adrenal glands size (left: 2.22 cm L × 0.80 cm W; right: 2.18 cm L × 0.88 cm W). Computed tomography scan of the brain showed a skull base tumor suggesting pituitary tumor (hypophysis), which confirmed the findings on the previous clinical examination. The tumor was compressing adjacent structures on the left side and causing the neurological deficits. The persistent intracranial pressure led to arterial occlusion and pressure on cranial nerves causing the paralysis of the brain. The blood test revealed an increase of serum alkaline phosphatase (5,838 UI/L), an increase of serum alanine aminotransferase—ALT (961 UI/L) and an increase of aspartate aminotransferase—AST (118 UI/L). Leukocytes and bilirubin were also slightly increased. The ketogenic diet was prescribed. The keto diet consists in the replacement of carbohydrates by healthy fats, which are converted to ketones, and in the intake of moderate amounts of high-quality protein to metabolize ketone bodies as an alternative fuel, when glucose availability is low. After 6 months on a keto diet, blood work results came with no more alterations. Zahn didn’t present neurological dysfunctions anymore and the following clinic check-ups were all in accordance with normal healthy parameters. Rationale: There are alternatives other than conventional medicine. Diet must be included on therapy plans either as an adjuvant or whenever possible as the main treatment. Nutrition plays an important role in the future of medicine. The ketogenic diet is an effective nontoxic metabolic therapy that can provide antiangiogenic and proapoptotic mechanisms. In Zahn’s case, it suggests that tumor cells have reduced the ability to metabolize these ketone bodies for energy. The ketogenic diet can offer hope against cancer, both for prevention and treatment, and those interested in cancer prevention should know about this. Objectives: This study is here to demonstrate the effectiveness of ketogenic diet as adjunctive therapy in the treatment of brain tumor. Although the study was done in a dog, it is known that ketogenic diet is also effective in preventing and reducing cancer risks in humans. Integrative Medicine conducted with criteria and responsibility leads to health and vitality for patients. Participants will know about this nontoxic alternative to help their patients and themselves. (3234) Integrative Psychiatry Curriculum for Psychiatry Residents Stefana Morgan, MD1, Ning Zhou, MD1, Selena Chan, DO1 and Sudha Prathikanti, MD1 1San Francisco, California Abstract Overview/Background: Based on National Health Interview Survey data, one third of U.S. adults use a complementary modality annually and adults with neuropsychiatric symptoms have a significantly greater prevalence of complementary modality use. As growing evidence supports the efficacy of many complementary therapies in treating mental health issues, integrating such therapies into conventional psychiatric care will likely enhance therapeutic outcomes. The Integrative Psychiatry Elective at University of California San Francisco (UCSF) addresses the need for psychiatry residents to be educated in integrative approaches to mental health care. Program Description: Participants in the course were able to learn about key elements of an integrative psychiatry approach to mental health care. Based on clinical factors, residents also learned to identify patients likely to benefit from an integrative psychiatry approach and evaluate efficacy data, risks, benefits, and contraindications of complementary therapies for psychiatric conditions. Via the experiential component of this course, participants had the opportunity to practice applying selected complementary therapies amenable to an office setting (eg, yoga breathing exercises for anxiety reduction). Additionally, residents learned to identify licensing and professional safety boards for complementary care providers in the community, and independent labs that test safety and quality of nutraceuticals and herbal products. Finally, participants learned to apply practice guidelines for communicating with and monitoring patients who have complementary care providers in the community. Mixed methods data were collected in order to assess the impact of the course. Survey data collected over 2 iterations of the elective demonstrate increased clinical competency of residents in understanding and using complementary modalities as well as in collaborating with complementary medicine experts in comanaging patients. Conclusion: This innovative curriculum was successfully implemented in the UCSF psychiatric residency training program and may offer a model to other clinical training programs for advancing knowledge of integrative mental health care. Rationale: Some complementary therapies require expert nonconventional practitioners to administer them, while others may be applied by practitioners having traditional medical backgrounds with only minimal training in complementary therapies. Psychiatry residents should be educated in integrative approaches to mental health care in order to better understand them, utilize them, and work collaboratively with other practitioners to enhance therapeutic outcomes. Objectives: The aim is to identify the learning needs of psychiatry residents with respect to understanding and implementing integrative mental health care; describe the components of the UCSF Integrative Psychiatry Curriculum designed to address these needs; and describe the effectiveness of the UCSF Integrative Psychiatry Curriculum in meeting the educational needs of residents, as measured by both qualitative and quantitative outcomes. (3235) Yoga Referrals—More to It Than Meets the Eye Rosanne Sheinberg, MD1 and Amy G Kozak1 1Baltimore, Maryland Abstract Overview: More data exist for practitioners to recommend the use of yoga to patients for various medical diagnoses. There is some confusion, however, exactly how to thoughtfully refer a patient to an appropriate setting of yoga, as all styles, practitioners and classes are not created equal and not suitable for all types of medical conditions. Rationale/Background: Yoga is rooted in a rich and long Indian tradition dating back over 5000 years. Since taking root in the United States, many styles of yoga have developed, including the highly popularized and medically tied, Hatha Yoga. More data exist for practitioners to recommend its use to patients for various medical diagnoses. There is some confusion, however, exactly how to thoughtfully refer a patient to an appropriate setting of yoga, as all styles, practitioners, and classes are not created equal and not suitable for all types of medical conditions. Teaching Point: There is currently a divide in the yoga certification community that causes confusion. Yoga Alliance currently tracks the individual training hours, ongoing education, and the credibility of yoga schools and training courses for yoga teachers starting with RYT200 (Registered Yoga Teacher). The International Association of Yoga Therapists is specifically interested in bridging yoga and health care. They require about 1000 h of instruction. To complicate matters, there are also master’s level programs. Many yoga teachers find themselves working in various settings—crossing the thresholds of both gyms and clinics. The bottom line for the medical community is that there exist options for matching a medical condition with the appropriate “yoga.” While some patients, for example with depression, may thrive at a general yoga class, this may not be the case for every patient, for example, a diagnosis of traumatic brain injury or sexual trauma. Therefore, it is important to note that medical providers have a bigger responsibility when it comes to patient-centered care; the difference between yoga and yoga therapy must be understood when making any referral. It is no longer appropriate to simply tell a patient, “you should try yoga.” Conclusion: A larger evidence base exists to begin recommending yoga to certain patient populations and medical conditions. Clinicians need education and guidance to appropriately refer a patient to an appropriate yoga provider and setting. Objectives: The aim is to understand different levels of yoga training and affiliated training requirements and understand the responsibility of providers to refer patients to an appropriate yoga setting. (3238) Mindfulness for Health-Care Professionals: A Long-term Follow-up and Mixed-methods Investigation of an Interdisciplinary Course Patricia Kinser, PhD, WHNP, RN1, Andrew Harris, BSN1, Caroline Carrico, PhD1, George Deeb, MD, DDS1, Alan Dow, MD, MSHA1 and Sarah E Braun, MS1 1Virginia Commonwealth University, Richmond, Virginia Abstract Purpose: Mindfulness-based interventions (MBIs) may help reduce health-care professional (HCP) burnout and stress-related outcomes. However, few studies have investigated the long-term effects of MBIs in interdisciplinary HCPs. Furthermore, more research is needed to better understand HCP perceptions of mindfulness’ effects and practice in the context of HCP work. Therefore, the purpose of the present study was to evaluate the effect of an MBI for interdisciplinary HCPs over time and at a long-term follow-up and to explore perceived benefits, facilitators, and barriers to the practice of mindfulness following an MBI for HCPs (MBSR-HP). Results: Eighteen HCPs (88% female) participated in the study. Significant reductions were found for 2 subscales of burnout: depersonalization; F(2, 17) = 5.98, P = .01, emotional exhaustion F(2, 17) = 2.64, P = .10. Nonsignificant reductions were found for perceived stress, depressive symptoms, rumination, and anxiety. Three facets of dispositional mindfulness showed significant increases at the long-term follow-up, act aware: F(2,15) = 4.47, P = .03, nonjudge: F(2, 15) = 4.7, P = .03, and nonreactivity: F(2, 15) = 3.58, P = .05. Benefits and facilitators of the continued practice of mindfulness skills included using informal practices and perceived improvements in emotion regulation. Participants reported that integration of mindfulness into their lives was the greatest barrier and the greatest facilitator. Conclusions: MBSR-HP showed long-term benefit in burnout and dispositional mindfulness. A larger, controlled study should confirm these findings and explore potential moderators for which this study was underpowered. Themes revealed the importance of developing a mindfulness practice that can be integrated into the context of HCP work. (3239) Prevalence and Correlates of Black Cohosh Consumption in the United States Kim Innes, PhD, MSPH1, Chris D’Adamo, PhD2, Elizabeth A Parker, PhD, RD3 and Termeh Feinberg, PhD, MPH4 1West Virginia University School of Public Health, Morgantown, West Virginia 2University of Maryland Baltimore School of Medicine, Baltimore, Maryland 3University of Maryland School of Medicine, Baltimore, Maryland 4Center for Integrative Medicine, Baltimore, Maryland Abstract Purpose: Although the herbal supplement Black Cohosh is anecdotally used to treat menopausal symptoms, rheumatic disorders, and other conditions, the prevalence and correlates of use in the United States remain unknown. In this study, we estimated Black Cohosh consumption in a weighted national sample and assessed variation in use by demographics, lifestyle factors, and health conditions. Results: Black Cohosh was used by an estimated 402 003 adults (0.41% of the U.S. population); users were less likely to be minority (adjusted odds ratio [AOR] for black vs white adults = 0.2, confidence interval [CI] 0.1, 0.6) and male (AOR = 0.1, CI 0.0, 0.2). Black Cohosh use was 6–8 times more likely to be reported by participants: aged 45–64 years than by younger adults (AOR = 8.1, CI 3.6, 18.0); with out-of-pocket medical costs over $2000 (AOR = 7.1, CI 1.6, 31.1); using other CHAs (AOR = 6.2, CI 2.1, 18.0); and reporting herbalist visits in the past year (AOR = 7.6, CI 2.8,20.4). Users were more likely than nonusers to delay medical care due to cost (AOR = 3.1, CI 1.8,5.4). Users were 11 times as likely to report menopausal symptoms (AOR = 11.1, CI 6.7, 18.5), and over twice as likely to report chronic rheumatic pain (AOR = 2.3, CI 1.3, 4.2), migraine (AOR = 2.3, CI 1.3,4.1), and mental health conditions (AOR = 1.8, CI 1.13.1). Conclusions: Although reported use of Black Cohosh was low in this national cross-sectional study, consumption was strongly and positively associated with menopausal symptoms, rheumatic pain, and mental health conditions. (3241) Ginkgo Use in the United States: Characteristics of Users and 5-Year Trends Termeh Feinberg, PhD, MPH1, Chris D’Adamo, PhD2, Kim Innes, PhD, MSPH3 and Ryan C Costantino, PharmD, BCPS4 1Center for Integrative Medicine, Baltimore, Maryland 2University of Maryland Baltimore School of Medicine, Baltimore, Maryland 3West Virginia University School of Public Health, Morgantown, West Virginia 4University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland Abstract Purpose: Although the herbal supplement, Ginkgo biloba, has been used to treat memory disorders and other conditions and is widely sold in the United States, prevalence and patterns of Ginkgo consumption remain little explored. In this study, we estimated Ginkgo herbal supplement consumption in 2 weighted national samples and assessed variation in use by sociodemographic factors, lifestyle characteristics, and health conditions. Results: Ginkgo use significantly decreased between 2007 and 2012, and was used by an estimated 1 382 659 adults (1.4% the U.S. adult population; weighted confidence interval [CI] 1.2%–1.6%) in 2007 and 828 340 adults (0.8% of the U.S. adult population; CI 0.7%–0.9%) in 2012; Ginkgo use was nearly twice as likely to be reported by participants: aged 45–64 years than by younger adults (2007 and 2012 odds ratios [ORs]: 1.6–1.9, respectively); former smokers (adjusted odds ratios [AORs] = 1.6); those delaying medical care due to cost (AORs 2.1–2.3); and who reported migraine in 2012 (AOR = 1.9, CI 1.3, 2.6), mental health condition in both years (AORs = 1.4–1.9), and memory loss in 2007 (AOR = 1.7, CI 1.1, 2.6). Ginkgo use did not vary among those with headache. Those using other complementary approaches were also 18–36 times as likely to report Ginkgo use (AORs = 18.4–35.8). Conclusions: In this national cross-sectional study, Ginkgo supplement use significantly decreased between 2007 and 2012. Ginkgo consumption was significantly higher in those experiencing migraine, memory loss, and mental health conditions. (3242) Ginseng Consumption in the United States: 5-Year Prevalence Trends and Correlates of Use Chris D’Adamo, PhD1, Kim Innes, PhD, MSPH2 and Termeh Feinberg, PhD, MPH3 1University of Maryland Baltimore School of Medicine, Baltimore, Maryland 2West Virginia University School of Public Health, Morgantown, West Virginia 3Center for Integrative Medicine, Baltimore, Maryland Abstract Purpose: Although the herbal dietary supplement Ginseng is anecdotally used for increasing resistance to a wide variety of stressors within the body and is widely sold in the United States, prevalence and patterns of Ginseng consumption remain unclear. In this study, we estimated Ginseng herbal supplement consumption in 2 weighted national samples and assessed variation in use by sociodemographic factors, lifestyle characteristics, and health conditions. Results: Ginseng use significantly decreased between 2007 and 2012 from an estimated 1.6% (confidence interval [CI] 1.4%–1.8%) of the U.S. adult population (N = 1 559 834 adults) in 2007 to 0.8% (CI 0.7%–1.0%) of U.S. adults (N = 857 482) in 2012. Males were significantly more likely to use Ginseng (2007 and 2012 adjusted odds ratios [AORs]: 1.4–1.6, respectively), as were adults who delayed medical care due to cost (AORs 2.1–2.2); were former smokers (AORs 1.6–1.9); or had chronic rheumatic pain/conditions (AORs 1.7), migraine (AORs 1.5–1.6), GI conditions (AORs 1.3-2.0), insomnia (AORs 1.8–2.0), or memory loss in 2012 (AOR = 1.9, CI 1.1, 3.1). Participants indicating use of other CHAs were also 10-11 times as likely to report using Ginseng (AORs 9.6–11.1). Conclusions: Ginseng supplement use decreased between 2007 and 2012 in this national cross-sectional study. Ginseng consumption was significantly higher in those experiencing rheumatic pain, gastrointestinal conditions, migraine, or memory loss. (3244) The Multidimensional Assessment of Interoceptive Awareness Questionnaire: Benefits, Shortcomings, Controversies Wolf E Mehling, MD1 1San Francisco, California Abstract Purpose: Since its 2012 publication, the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire has been translated into 20 other languages for application in mind–body research. Interoceptive bodily awareness has emerged as a key topic in understanding mind–body approaches. This presentation will summarize research with the MAIA, its potential benefits for mind–body research, shortcomings, controversies, and ongoing improvement efforts. Results: The 8-scale 32-item MAIA differentially modifies aspects of the complex construct of interoceptive awareness with mind–body approaches, highlighting key domains of regulatory aspects of interoceptive awareness. Not-distracting mediates the effect of a mind–body approach to comorbid depression and chronic pain. Self-regulation and attention regulation enhance the ability to decenter mediating the effect of mindfulness training on depressive symptoms. Fitness training integrated with mindfulness and yoga improves interoceptive awareness in parallel with post-traumatic stress disorder symptoms. Translations into foreign languages confirmed the factor structure with exceptions potentially due to cross-cultural differences, which are currently explored by focus groups. Two of the 8 scales consistently showed low Cronbach’s alphas prompting a revision of their items in preparation for an MAIA version 2. MAIA scores for interoceptive awareness are independent of interoceptive accuracy but related to altered activation in brain regions involved in monitoring body state. Conclusions: The MAIA fills an important gap in mind–body research. A revision of 2 of its eight scales is underway. Controversies regarding the underlying construct and cross-cultural differences in bodily awareness require further research. (3245) Mind–Body Practices Delivered in a Cancer Infusion Suite to Reduce Symptoms and Improve Well-being: A Practice-based Study Sian Cotton, PhD1, Ellen N Drosdick, MS1, Tina Walter, BA1 and Harini Pallerla, MS1 1Cincinnati, Ohio Abstract Purpose: Anxiety, pain, nausea, and fatigue are common side effects of patients undergoing chemotherapy. Mind–body practices (eg, yoga therapy, relaxation/breathwork, mindful awareness, auricular acupuncture) have been shown to be effective in reducing symptoms in outpatient settings. The purpose of this practice-based study was to assess the use of mind–body practices delivered at the point of care during cancer infusion and to examine changes in symptoms before and after the intervention. Results: One hundred ninety-one patients, with various cancers and blood disorders, participated in this study from April 2016 to July 2017, with 86% (n = 165) of participants completing both pre- and postsurveys. Levels of anxiety (Mpre = 3.61/Mpost = 1.73, P < .01), pain (Mpre = 1.82/Mpost = 1.02, P < .01), nausea (Mpre = .72/Mpost = .326, P < .05), and overall distress (Mpre = 3.48/Mpost = 1.83, P < .01) all significantly decreased post intervention. Furthermore, 32% of participants (n = 22) spontaneously reported that the treatment was relaxing and/or soothing. Conclusions: In this practice-based study, clinical symptoms significantly decreased following a mind–body intervention in a cancer infusion suite delivered at the point of care. Future studies should use objective raters to assess symptom reduction. Mind–body practices delivered during infusion services may provide symptom reduction for patients and should be rigorously assessed for dose, individualized preference, and long-term symptom improvement. (3246) Paper-based Colorimetric Analysis of Mushroom Extracts: Effects of Mushroom Variety, Brew Time, Reinfusion, and Extraction Method on Antioxidant Activity Erica M Sharpe, PhD1, Tom Huber, MS2, Sylvia Ludlam3, Margaret Walker3, Silvana Andreescu, PhD4 and Ryan Bradley, ND, MPH1 1National University of Natural Medicine, Portland, Oregon 2Paul Smith’s College, Paul Smiths, New York 3SUNY Canton, Canton, New York 4Clarkson University, Potsdam, New York Abstract Purpose: This study investigates the effects of infusion time and reinfusion on the antioxidant (AOX) activity of Inonotus obliquus (ie, chaga) as well as the differences in AOX activity between 12 double-extraction mushroom tinctures (Fomes fomentarius, Fomitopsis pinicola, Ganoderma applanatum and tsugae, Hericium americanum, Inonotus obliquus, Lentinula edodes, Phellinus igniarius, Piptopous betulinus, Pleurotus ostreatus, Trametes versicolor, and 1 mixture of all samples). Results: Antioxidant activity values ranged from 1.81 ± 0.16 to 24.77 ± 6.51 mM GAE, with the highest activity coming from P. igniarius (ie, fire sponge), and the lowest detectable activity coming from L. edodes (ie, shiitake). H. americanum (ie, lion’s mane), P. betulinus (ie, birch bracket), and P. ostreatus (ie, oyster) showed no activity using this method. Several samples were notable including the tincture of all 11 mushrooms combined (21.08 mM GAE); F. fomentarius (ie, tinder fungus), 10.51 mM GAE; and G. applanatum (ie, artist conk), 10.33 mM GAE. Decoctions of chaga showed a direct relationship between brew time and AOX activity, with the AOX activity of a 4-h brew reaching nearly 90 mM GAE (more than 10 times stronger than a cup of tea). When decocted a second time, the AOX activity of chaga was less than half that of the first extraction. Conclusions: Our results highlight the notable AOX activity of P. igniarius, and further support the mixing of varietal mushroom for an AOX-rich solution. Our work confirms the high AOX activity of chaga and displays its usefulness throughout repetitive infusions and varied infusion lengths. (3247) Integrating Mindfulness Classes into Primary Care Clinics: Clinical and Financial Considerations Abigail Zeveloff, MSW, MPH1, Amy Locke, MD1, Bernadette Kiraly, MD1, Ruben Tinajero, MS1 and Katherine Fortenberry, PhD1 1Salt Lake City, Utah Abstract Overview: Group therapy is an effective way to manage high patient case loads while providing skill-based, behavioral treatment options. Mindfulness skills, in particular, are effective treatment options for a variety of mental health and medical conditions frequently seen in primary care. The use of Health Behavior Assessment and Intervention (HBAI) codes provide innovative ways to medically bill for behavioral group therapy visits. Mindfulness group sessions, billed under these HBAI codes, offer patients timely, supportive, and skill-based behavioral health therapy with a medical visit copay. Rationale: Recent developments in primary care models support the integration of behavioral health within patients’ primary medical homes. Despite benefits of improved access and reduced stigma, barriers of long appointment wait times and poor behavioral health insurance coverage remain. In 2 busy, primary care clinics, we are addressing these barriers by developing 4-week mindfulness classes which are billed through patients’ medical insurance using HBAI codes. Group treatment is an ideal model of delivering behavioral health interventions within medical clinics due to: management of high-volume caseloads within a single, behavioral health appointment slot; providing patients with concrete, behavioral skills; and the effectiveness of group therapy in treating depression and anxiety with the added benefit of social learning. Mindfulness skills have been shown to be effective in the treatment of conditions frequently seen in primary care. The mental/behavioral health carve out of medical insurance often do not adequately cover psychotherapy services, thus leaving patients with session limits, high deductibles, and/or high copays. HBAI codes provide a financially innovative way to medically bill for group treatment, typically having the same out-of-pocket expenses as a primary medical care appointments. HBAI appointments offer greater flexibility for working with patients on targeted, health-related interventions in individual, 15-min increments as well as up to 90-min group therapy. Through offering time-limited, mindfulness group classes, primary care clinics are able to provide patients with timely, affordable, skill-based behavioral health treatment. Furthermore, clinics are able to diversify billing structures for behavioral health visits while providing clients with in-house, integrative treatment options. Objectives: The aim is to identify appropriate presenting issues for mindfulness groups; identify ways in which to develop and recruit for behavioral health groups; and generate a broad understanding of uses for HBAI billing codes. (3252) Promoting Research in Complementary and Integrative Health: A Framework for Undergraduate Engagement Deanne Tibbitts, PhD1, Heather Zwickey, PhD1, Morgan Schafer, MA1 and Megan Golani, ND1 1National University of Natural Medicine, Portland, Oregon Abstract Overview/Background: Many colleges and universities provide opportunities for undergraduate students to engage in biomedical research. However, opportunities for undergraduates to engage in complementary and integrative health (CIH) research are limited. Program Description: Here, we describe a framework for promoting CIH research among undergraduates through an immersive, 8-week internship program at a research institute within a CIH-centered university. Students engage in (1) an introductory course on CIH, (2) small group discussions with CIH research faculty, and (3) development and execution of an evidence-based personal intervention project. Self-reported assessment of learning outcomes showed that students improved their CIH research skills by the end of the program. Exit interviews indicated that mentoring was a key component of the educational experience. Conclusion: Adoption of this framework may improve research skills and foster interest in CIH research among undergraduate students. Rationale: The goal of the program we have created is to advance integrative health by inspiring the next generation of CIH clinicians and scientists. Our program does this by engaging undergraduate students in CIH research through a combination of research, education, and exposure to clinical practice. Objectives: Participants will learn about successful elements to include when creating a CIH-focused research internship program for undergraduate students. (3256) Crowdsourcing Clinical Research: Feasibility of Amazon Mechanical Turk for Obtaining National Data About Adults With Chronic Pain Ron D Hays, PhD1, Ian D Coulter, PhD2 and Lara G. Hilton, MPH2 1University of California, Los Angeles, Los Angeles, California 2RAND Corporation, Santa Monica, California Abstract Purpose: This study compares estimates of demographic characteristics, health-related quality of life (HRQOL) and pain outcomes of adults with chronic low back pain in the United States using crowdsourced data (Amazon Mechanical Turk [AMT]), and data collected from 1129 patients in 125 chiropractic clinics from throughout the United States. Results: The AMT sample was significantly younger, less educated, with lower average annual income than chiropractic patients in the national sample; after adjusting for the confounder chiropractic utilization, there were no significant mean differences in pain and HRQOL between the AMT and national chiropractic samples. The AMT data cost approximately $15 per respondent in incentives, while the national sample cost was $200 per respondent. Conclusions: The AMT sample differed on some demographic characteristics but was similar in pain and HRQOL to a national sample of chiropractic patients after controlling for utilization. The results of this study suggest that estimates of patient-reported pain outcomes might be obtained using relatively inexpensive crowdsourcing data collection platform. (3257) Evaluation of Extended Practice and Workplace Integration Following a Yoga-based Program for Workplace Professionals Natalie L Trent, PhD1, Mindy Miraglia, MS2, Sat Bir S Khalsa, PhD1, Jeffrey A Dusek, PhD3 and Edi Pasalis, MBA2 1Brigham and Women’s Hospital, Boston, Massachusetts 2Kripalu Center for Yoga & Health, Stockbridge, Massachusetts 3Aurora Health Care, Milwaukee, Wisconsin Abstract Purpose: This study examined the level of integration of practices learned in a yoga-based program into the workplace and daily life, which has been a challenge for previous mind–body programs. Results: At post-resilience, integration, self-awareness, engagement (RISE) assessment, participants generally reported a plan to practice the skills/approaches learned in RISE (M = 73.1, standard deviation [SD] = ±25.6), were likely to share the skills/approaches they learned with others (M = 91.0 ± 10.6), and that it was feasible to accommodate RISE practices into their schedule (M = 80.8 ± 18.9). At follow-up, participants reported that they continued to practice RISE approaches (M = 61.0 ± 26.2). Most participants reported they observed a positive shift in their workplace (M = 64.2 ± 16.4) and that they shared skills/approaches with others (M = 71.0 ± 15.6). Qualitatively, as in the post-RISE assessment, participants indicated continued practice of yoga, mindfulness, breathing techniques, meditation, and experienced greater self-care, compassion, and health due to RISE. Participants incorporated and shared mindfulness, breathing techniques, mindful communication, and self-care practices in their workplace. They described that their organization had benefited from RISE by increasing the self-care and mindfulness of colleagues. Conclusions: The 5-day RISE program resulted in participants reporting a wide range of psychosocial and organizational benefits. Participants reported continued long-term use of the RISE practices in their workplace and home. (3259) Partially Randomized Controlled Trial Considering Patient Preference in Comparative Evaluation of Nonpharmaceutical Therapy of Traditional Chinese Medicine Hui Hu, PhD1, Xin-lin Li1, Huijuan Cao, PhD2, Jian-ping Liu, PhD1, Tian-jiao Li, PhD1, Zhan-guo Xie3 and Ya-jing Zhang1 1Beijing University of Traditional Chinese Medicine, Beijing, China 2Beijing University of Chinese Medicine, Beijing, China 3The First Hospital in the Eastern District, Beijing, China Abstract Purpose: To investigate the feasibility of applying partially randomized patients’ preference (PRPP) trial in clinical evaluation of cupping therapy versus acupuncture. Results: There were 4 parallel groups: randomized cupping (30 cases), nonrandomized cupping (27 cases), randomized acupuncture (30 cases), and nonrandomized acupuncture (39 cases; Figure 1). The primary outcomes showed nonrandomized participants completed the recruitment 8 months earlier. Though totally 21 (16.67%) participants dropped out with no statistical difference between randomized and nonrandomized participants (P = .62), almost all cases of dropped out of nonrandomized patients were happened before we decided to return the cost if the treatment completed. After adjusting the impact of the strategy change, the drop-out rate of nonrandomized participants might be 7.6% lower than of those who were randomized allocated. Neither the patients’ expectation before treatment (P = .89, over 30% of the participants expect to be cured) nor the patients’ satisfactory after treatment (P = .43, probably 40% of the participants reported very satisfied to the treatment) showed statistical difference related to the grouping method. When assessing the effect of acupuncture and cupping on pain relief, both of them made clinical meaningful reduction of pain intensity (mean difference of visual analogue scale was—37.47 mm, 95% confidence interval from −42.08 mm to −32.87 mm, P < .0001). However, no difference was found between these 2 therapies (P = .77) as well as other pain intensity assessment scores. Conclusions: PRPP model may shorten the study duration and decrease the drop-out rate. Since it may control the impact of patients’ preference on outcome measurement (when lack of blinding methods), PRPP model may be suitable to be applied in clinical evaluation of nonpharmaceutical therapy of traditional Chinese medicine. (3261) The Integrative Medicine Bubble Tyler Phan, PhD1 1Goldman Institute for Social Research, Pittsburgh, PA Abstract Purpose: The pupose of the paper is to provide insight on the possible risks and legitimacy of integrative medicine modalities in the United States. The research focuses around the curriculum and standards of integrative medicine throughout the country. Through a 3-year long survey of integrative medicine practices across the nation, the evidence indicates a looming financial catasrophe. Results: There is evidence to support the vast majority of curriculum of integrative medicine does not reflect a focus on patient safety. Instead, much of the curriculum is based on the dominance of a homogenous abstract medical theory. This theory supersedes other tradtions’ medical theories in the attempt for standardization. This results in an inadequate standard for a patient-centered care, the threat of a homogenous medical tradition while marginalizing of other traditions, and the accruement of debt for students from their education. Conclusions: The data demonstates an inevitable crisis in the pedagogical approaches to integrative medicine. If policy does not change to take in consideration all of the issues provided in this paper, many professions will fail and leave a whole generation in debt all while failing the safety of patients. (3290) Exploring Perceptions Pertaining to Spiritual Care Religiousness/Spirituality and Traditional Medicine Among Different Countries Using a Text Mining Approach Hideaki Tanaka, PhD1, Kiyoshi Suzuki, MD, PhD1 and Tomoaki Kimura, PhD1 1MOA Health Science Foundation, Atami-shi, Japan Abstract Purpose: To examine common understanding about spiritual care and opinion toward incorporating spiritual care and traditional medicine into medical care. Methods: The international committee of the Japan Society of Integrative Medicine conducted an electronic survey toward medical professionals, government, and administrative staff from 14 different countries (Japan, United States, Central & South America, Southern Europe, Asia, Democratic Republic of Congo), which was translated into 7 different languages prior to distribution. Survey questions regarding the participants’ opinion about (1) spiritual care and (2) challenges in incorporating traditional medicine and religiousness/spirituality into conventional medicine were analyzed qualitatively through a text mining approach using SPSS Text Analysis for Surveys 3.0. Results: Data from 505 participants were analyzed, more than half (54.2%) were either medical doctors or other medical staff. Responses from the first question on spiritual care were classified into 16 categories. “Important” and “needed” were the 2 most common categories extracted, others included “medical treatment,” “mind,” “spiritual,” “human,” “religion,” and “purpose of life.” Categories maybe related to terminal care such as “terminal” “pain” and “alleviation” were also extracted. More than 20 categories were extracted from responses to the second question. Most common were “religion,” “medical care,” and “person.” Next, “inclination,” “health,” and “disease” were common. “Religion” has both a positive and negative aspect, descriptions on challenges toward incorporating religiousness/spirituality into modern medicine were observed. Participants described “inclination” toward science or a specific religion to be problematic. “Disease” was derived from opinions which discussed the benefits of incorporating traditional medicine and religiousness/spirituality into medicine in the process of recovery from disease. The present survey did not include questions regarding religious affiliation and religious views, therefore the relationship with the study results is unknown. Conclusion: Many participants believed spiritual care to be important, however, many believed there to be challenges in incorporating reigiousness/spirituality into medicine. (3293) Mindfulness-based Stress Reduction and Yoga for Treating Chronic Headache: Systematic Reviews and Meta-analyses Petra Klose, PhD1, Matthew J Leach, PhD2, Dennis Anheyer, MA1, Holger Cramer, PhD1 and Gustav Dobos, MD, PhD1 1University of Duisburg-Essen, Essen, Germany 2University of South Australia, Adelaide, Australia Abstract Purpose: Mindfulness-based stress reduction (MBSR) and yoga are 2 mind–body techniques frequently used to treat pain-related conditions, but their effects on headache symptoms remain uncertain. The aim of this presentation is to report the findings of 2 systematic reviews examining the efficacy and safety of MBSR and yoga in patients with chronic headache (ie, migraine and/or tension-type headache). Results: After full-text screening, 4 randomized controlled trials (RCTs) with a total of 177 patients treated with MBSR and 5 RCTs with a total of 251 patients treated with yoga were eligible for quantitative analysis. While yoga significantly reduced headache frequency (5 RCTs; standardized mean difference [SMD]: −1.97 [95% CI: −2.75 to −1.19]), duration (4 RCTs; SMD: −1.46 [95% CI: −2.54 to −0.37]) and intensity (5 RCTs; SMD: −3.44 [95% CI: −6.08 to −0.79]) in comparison to usual care, no evidence was found for MBSR in reducing any of these outcomes when compared to usual care. Only 1 study on MBSR reported safety-related data, while none of the studies on yoga reported such data. Conclusions: Evidence supports the recommendation of yoga (but not MBSR) as an adjunctive therapy for patients suffering from chronic headaches. However, since study quality was mainly low, more rigorous RCTs are necessary to underpin this recommendation. (3301) Metaphor: The Language of Healers and Healing Paul A Dieppe, MD1, Sara Warber, MD2, Sarah Godlingay, PhD1 and Emmylou Rahtz, PhD1 1University of Exeter, Exeter, UK 2Ann Arbor University, Ann Arbor, Michigan Abstract Purpose: To explore how healing practitioners conceptualise healing. Methods: Self-identifying, practicing healers underwent in-depth interviews of 60–90 min, during which their views on healing were explored, and they were asked to tell stories about healing events. At the end of the interview, they draw a picture in response to the question – ‘what does healing mean to you?’ and what they said about the pictures as they drew was recorded. The interviews were transcribed, and qualitative analysis of both interviews and pictures undertaken. Results: A total of 26 subjects have been interviewed. Six subjects were qualified doctors, as well as self-identifying healers, the remainder were practicing Reiki, energy healing or spiritual healing outside the conventional medical system. Most subjects found it hard to talk about healing, many noting that they did not have the language to explain the experiences that surrounded their practice, or for the responses of their clients. Most resorted to the use of metaphor to try to explain the subject. This was most apparent when they drew pictures. The process of trying to draw what healing meant seemed to allow many to access new ideas, concepts and metaphors that had not arisen when they were talking rationally about the subject in the preceding interview. The most common metaphors used included: growth (eg, nurturing a seed into growth), restoration of wholeness (eg, pictures of order emerging from chaos, or of something being mended), energy channelling (the idea of energy transfer within the body, or into the body from outside), the value of nature (stories of the restorative power of nature), making connections between people (eg, pictures of individuals connecting together) and love (eg, pictures of hearts). Conclusions: Healing is an experiential issue, best described through the use of metaphor. (3303) The Experience of People Being Treated by Healers Sue Knight, BSc1, Sue Child, BSc2, Emmylou Rahtz, PhD2, Sara Warber, MD3 and Paul A Dieppe, MD2 1Confederation of Healing Organisations, London, UK 2University of Exeter, Exeter, UK 3Ann Arbor University, Ann Arbor, Michigan Abstract Purpose: To gain further understanding of the experience of clients being treated by spiritual or energy healers. Methods: The UK Confederation of Healing Organisations (CHO) sent survey forms to their constitent healing groups as well as individual healers, asking for information about individual healing encounters. The data sought included information on the age and gender of client, the main reasons for their seeking healing, the experiences of the client and their perceptions of the ‘outcome’. Results: A total of 281 completed forms, each relating to a single client–practitioner interaction, were obtained and have been analysed both quantitatively and qualitatively. The healers identified themselves as predominantly spiritual, Reiki or energy, healers and used a variety of different techniques to activate healing. Clients were predominantly female (76%) with an age range of 19 to 90 (median 55). The main reasons for seeking healing were mental health problems, musculoskeletal disorders, pain and fatigue. Ninety-three percent of clients reported some immediate benefit. The most commonly reported outcomes were relaxation (57%) and improved general well-being (29%). In addition, many reported physical effects, including feelings of warmth and heat (16%), relief of pain (14%), being energised (13%), seeing colours (5%) and sensations of pressure or tingling (5%). Many clients reported being amazed by the effect, for example, one said, ‘I think it’s brilliant. I don’t understand it, but it bloody works’. Conclusions: Treatments by healers can induce significant relief of symptoms and improvements in well-being and can also result in unusual physiological responses. (3304) Creating a Healing Space Within a General Hospital Corridor Paul A Dieppe, MD1, Emmylou Sara Warber, MD2, Lisa Rahtz, PhD1, Deborah Harty, BSc3, Sarah Weinreb, BSc4 and Godlingay PhD1 1University of Exeter, Exeter, UK 2Ann Arbor University, Ann Arbor, Michigan 3Musgrove Park Hospital, Taunton, UK 4Bristol, UK Abstract Background: Healing is difficult to talk about or describe, as it is essentially an individual experiential phenomenon or process, rather than a definable ‘thing’. Therefore, it may be easier to open conversations about healing through exhibitions and experiences, rather than written material. Methods: We have been undertaking interviews with doctors, healers, their clients and members of the general public in a variety of different places. In most instances, we posed the question ‘what does the word healing mean to you?’ We have obtained drawings as well as spoken or written answers to this question. Some of these responses were used to develop an artistic exhibition to be shown in a large General Hospital in South West England. Quotations about healing and responses for interviewees were put together around 4 emergent themes: (1) the many ways of being broken, (2) connections with others and with the natural world, (3) healing at the end of life’s journey and (4) wholeness and oneness. In addition, a ‘cabinet of healing curiosities from around the world’ was displayed. The exhibition was displayed in a busy corridor of the hospital for 5 months. Responses were obtained from people viewing the exhibition through written feedback, brief interviews and via a focus group with hospital staff. Some people found it difficult to relate to the exhibition, or thought it confusing, but the vast majority, particularly patients and nursing staff k, were enthusiastic. Many described it as a ‘healing space’ and patients as well as staff said they came to look at it again and again to help them in their own healing journeys. A few people described it as transformational for them. Conclusions: Healing exhibitions can be of great value within general hospitals. (3310) Comparisons of Integrative Medicine Group Visit and Clinical Visits in Improving the Application of Adaptive Stress Management Techniques Among Patients With Chronic Pain and Depression Man Luo, MPH1, Paula Gardiner, MD, MPH1 and Salvatore D'Amico, BS1 1Boston, Massachusetts Abstract Purpose/Background: For low-income racially diverse patients with chronic pain and depression, high stress levels are very common. Integrative Medicine Group Visits (IMGV) teach the principles of Mindfulness and Evidence-Based Integrative Medicine Techniques such as stress management techniques. This analysis aims to compare the effectiveness of IMGV group to a clinical visit in improving applications of adaptive stress management techniques. Results: This study included 155 participants, among which 86% were female, 58% were self-reported Black, and the average age was 50. At baseline, participants who did exercise had significantly lower pain medication use (P = .04) and opioid use (P < .01) than those did not exercise. For summary scores, intervention group had more adaptive techniques than control group at week 9 (P = .09) and week 21 (P = .14). The use of nonadaptive stress management techniques was similar between intervention and control groups. For individual adaptive techniques, there was a significant increase in doing exercise among intervention participants at both week 9 (risk ratio [RR]: 3.25, confidence interval [CI]: 1.14, 10.47) and week 21 (RR: 4.05, CI: 1.18, 15.75) compared to control group. Intervention group also had a significant increase in doing meditation compared to control at week 9 (RR: 7.98, CI: 2.37, 33.00) adjusted for baseline meditation. Conclusions: The study suggested that IMGV is a good method to increase participants’ positive stress management techniques such as doing exercise and meditation. (3315) Mindfulness-based Cognitive Therapy for Depressed Individuals Improves Suppression of Irrelevant Mental-sets Jonathan Greenberg, PhD1, Sara W Lazar, PhD1, Benjamin G Shapero, PhD and David Mischoulon, MD, PhD 1Massachusetts General Hospital, Boston, Massachusetts Abstract Purpose: Depression is a leading cause of disability and one of the most common mental disorders. It is characterized by impaired ability to suppress competing or currently irrelevant mental sets such as distracting ruminative thoughts. Mindfulness-based cognitive therapy (MBCT) was specifically designed to help depressed individuals avoid getting caught in such irrelevant mental sets. However, is currently unknown whether MBCT can improve this ability, and how such benefits relate to improvements in depressive symptoms. Results: The MBCT group exhibited significantly lower depression scores and greater improvements in irrelevant mental-set suppression compared to a wait-list plus treatment-as-usual group. Moreover, improvements in mental-set-suppression were associated with improvements in depression scores. Conclusions: Results provide the first evidence that MBCT can improve suppression of irrelevant mental sets, a key cognitive deficit in depression, and that such improvements are associated with depressive alleviation. The potential role of improvement in cognitive functioning is discussed in the context of the efficacy of MBCT in treating depression and preventing relapse is discussed. (3317) Mindfulness-based Resilience Training to Reduce Health Risk, Stress Reactivity, and Aggression Among Law Enforcement Officers: A Feasibility and Preliminary Efficacy Trial Matthew Hunsinger, PhD1, Sarah Richard Goerling, MBA2, Cindy Bowen, PhD1, Jens Gross, PhD3, Michael Pruessner, PhD4 and Christopher, PhD1 1Pacific University, Hillsboro, Oregon 2Hillsboro Police Department, Hillsboro, Oregon 3Minneapolis, Minnesota 4McGill University, Quebec City, Quebec, Canada Abstract Purpose: As first responders who are frequently exposed to job-related trauma, law enforcement officers are at an elevated risk of adverse health outcomes. The stressful nature of policing and the substantial limitations of both tertiary and secondary prevention suggest a real need for primary prevention research on ways to increase resilience and reduce aggression. The primary objective of this study was to assess feasibility and gather preliminary outcome data on mindfulness-based resilience training (MBRT) for law enforcement officers. Results: Attendance, adherence, posttraining participant feedback, and interventionist fidelity to protocol all demonstrate feasibility of MBRT for law enforcement officers. Compared to waitlist controls, MBRT participants experienced greater reductions in salivary cortisol (AUCi), self-reported aggression, burnout, alcohol use, sleep disturbance, and increases in psychological flexibility and nonreactivity at posttraining; however, group differences were not maintained at 3-month follow-up. Conclusions: This initial randomized trial suggests MBRT is a feasible intervention, and a larger fully powered randomized Controlled trial is warranted. Outcome data suggest that MBRT targets key physiological, psychological, and health risk factors in law enforcement officers, consistent with the potential to improve officer health and public safety. However, follow-up training or “booster” sessions may be needed to maintain training gains. (3318) Effects of Mindfulness and Acceptance Interventions on Affect Tolerance and Sensitivity: A Systematic Review of Randomized Controlled Trials Kristen Kraemer, PhD1, Christina M Luberto, PhD2 and Gloria Yeh, MD, MPH2 1Beth Israel Deaconess Medical Center, Boston, Massachusetts 2Boston, Massachusetts Abstract Purpose: Affect tolerance/sensitivity, broadly defined as the ability to withstand negative emotional states, has been implicated in the development and maintenance of numerous forms of psychopathology, negative health behaviors, and chronic illnesses. Though considered a trait-like predisposition, affect tolerance/sensitivity factors are malleable and have been posited to improve with mindfulness and acceptance interventions. The aim of the current review was to synthesize the available literature evaluating mindfulness and acceptance interventions on affect tolerance/sensitivity. Results: Seventeen randomized controlled trials with 16 unique samples (pooled N = 1001) were included. Interventions ranged from 15 min to 12 weeks. Studies included outcomes of anxiety sensitivity (fear of arousal-related sensations; n = 8), distress tolerance (ability to withstand emotional distress; n = 6), and intolerance of uncertainty (inability to withstand uncertain states; n = 3). Most studies included healthy adults (25%), those with an anxiety disorder (25%), or substance use problems (19%). Mindfulness and acceptance interventions were associated with greater longitudinal improvements in affect tolerance/sensitivity compared to inactive controls (n = 7), similar improvements compared to active interventions (eg, cognitive behavioral therapy; n = 7), and greater short-term improvements compared to acute experimental conditions (eg, avoidance, rumination; n = 3). Studies were generally of moderate quality. Further formal meta-analysis is forthcoming. Conclusions: Mindfulness and acceptance interventions appear promising for improving affect tolerance/sensitivity across multiple populations. Future work is needed to determine whether specific mindfulness or acceptance interventions differentially improve affect tolerance/sensitivity and whether these improvements mediate treatment outcomes. (3319) Health-related Links Between Chronic Symptoms and Yoga Program Attendance Louise Mahoney, MS1, Linda Collery, MA1, Peter J. Bayley, PhD2, Melinda Wong, BS1 and Jennifer Hanft, MS1 1U.S. Department of Veterans Affairs, Palo Alto, California 2Palo Alto, California Abstract Purpose: Yoga is becoming increasingly popular as an adjunct therapy in health-care settings for a range of mental and physical health conditions. Despite a broad consensus that yoga may benefit health, many people do not attend classes, even when recommended by their health-care provider. We explored the health-related links between reasons for referral to a clinical yoga program and attendance. Results: The 3 most common reasons for referral were musculoskeletal pain (n = 67), stress/anxiety (n = 61), and health/wellness (n = 59). Only 45 (39.5%) of the sample attended at least 1 yoga class. Attendance varied according to the referral reason. Conditions with the best attendance rates included those referred for stress/anxiety (49%), meditation/mindfulness (46%), and symptoms of posttraumatic stress disorder (PTSD) (41%). Conditions having the poorest attendance rates included those referred for chronic fatigue (23%), nonmusculoskeletal chronic pain (24%), and musculoskeletal pain (27%). Veterans were also given a questionnaire (Mymop-2) over the phone to identify their main subjective health complaints prior to their first yoga class. These data showed a similar pattern such that the best attendance rates were those reporting mood disorders including depression, anxiety, and PTSD (59%). Likewise, the poorest attendance rates were those reporting musculoskeletal problems (33%) and chronic musculoskeletal pain (34%). Conclusions: The data indicate a systematic pattern. Those referred to the yoga program for stress or wellness were more likely to attend, perhaps due to the perceived mental health benefits of yoga. Those referred for chronic pain or other musculoskeletal problems were less likely to attend, perhaps due to the physical difficulty of attending. Further research is warranted to identify more precisely the reasons for attendance and nonattendance in clinical yoga programs. (3326) Group Yoga Effects on Cancer Patient and Caregiver Symptom Distress: Assessment of Self-reported Symptoms at a Comprehensive Cancer Center Alejandro Chaoul, PhD1, Catherine Powers-James, PhD1, Carol A Eddy, MPT1, Smitha G Mallaiah, MS1, Amie D Koronczok, MS1, Gabriel Lopez, MD1, Telma Gomez, MS1, Janet Williams, MPH1, Qi Wei, MS1, Eduardo Bruera, MD1 and Lorenzo Cohen, PhD1 1Houston, Texas Abstract Purpose: Complementary and integrative health approaches such as yoga provide benefits for psychosocial health. We explored the effects of group yoga classes available to patients and caregivers in the outpatient center of an integrative medicine program at a comprehensive cancer center. Results: Two hundred eighty-three unique participants (205 patients, 78 caregivers; 81% female, 74% Caucasian; ages 23–90) attended 1 or more yoga groups from July 18, 2016, to August 8, 2017. Eighty-nine percent of participants completed at least a preassessment; 65% completed both pre- and postassessments. Similarities in baseline symptom burden for patients versus caregivers included anxiety, pain, sleep and Edmonton Symptom Assessment System (ESAS) subscale of psychological distress (PSS; all P’s >.05). For all participants, we observed clinically significant reduction/improvement in physical distress, global distress, and PSS scores and in individual symptoms (ESAS decrease ≥1; means) of anxiety (−2.0), fatigue (−1.83), well-being (−1.68), depression (−1.2), appetite (−1.1), drowsiness (−1.0), and sleep (−1.0). Clinically significant improvement for both patients and caregivers was observed for symptoms of anxiety, depression, fatigue, and well-being and for all ESAS subscales. Clinically significant improvement was observed in the patient group only for appetite and drowsiness. Conclusions: A single yoga group class resulted in relief of multiple self-reported symptoms for both cancer patients and caregivers. Further research is needed to better track symptoms over time, to understand the symptoms that yoga can help control, and how differences in yoga class content and intensity can affect outcomes. (3329) Building Research Across Interdisciplinary Gaps Clinical Research Training Program in Complementary and Integrative Health Craig Scott, MD1, Cathryn Booth-LaForce, PhD1, Heather Zwickey, PhD2 and Ryan Bradley, ND, MPH2 1University of Washington, Seattle, Washington 2National University of Natural Medicine, Portland, Oregon Abstract Purpose: To present key design and evaluation features of a National Institutes of Health-funded multidisciplinary clinical research training program in complementary and integrative health (CIH) geared toward doctoral degree holders in both CIH clinical and conventional bioscience disciplines. Results: Clinical backgrounds of T90 fellows include doctors of acupuncture and oriental medicine (DAOM; n = 2) and naturopathic medicine (ND; n = 1). R90 research backgrounds include doctors of philosophy in toxicology (n = 1), nutrition and food science (n = 1), chemistry (n = 1), nursing research (n = 1), and genetics (n = 1). Mean results of Clinical Research Appraisal Inventory assessments upon entry to the program (n = 8) suggest moderate confidence in choosing a research topic (7.3), refining a study question (7.3), providing a scientific rationale (7.4), and expressing the idea in writing (7.6). Mean results suggest less confidence in providing direction to a statistician (2.1), performing specific statistical tests (3), preparing a project budget (3.25), connecting scientific designs to analytical methods (3.25), and ensuring data reliability (4.6). Mean scores increased in all areas of appraisal with increased years in training. Conclusions: By combining clinical research methodologies with immersive mentorship in the context of CIH, the UW-NUNM BRIDG program exemplifies a new standard for the multidisciplinary training of clinical researchers. (3330) A Collaborative Clinical Approach—Lessons Learned During a Pilot Sickle Cell Wellness Clinic Melanie Brown, MD1, Kristin Moquist, APRN, CNP1, Rae Blaylark, CHW1 and Ashley N Junghans-Rutelonis, PhD1 1Children’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota Abstract Overview: The Sickle Cell Wellness Clinic pilot period in 2017–2018 will include 12 - to 21-year-old youth with sickle cell disease (SCD) and their caregivers. Structured around feedback from an intensive family focus group, this monthly 1/2 day clinic, housed within Pain, Palliative Care, and Integrative Medicine (PPCIM) Department and including collaboration with the Department of Hematology/Oncology, will provide services in both individual and group settings with goals of increasing use of proactive coping skills and integrative medicine strategies. While pilot data will be mentioned, the major goal of the presentation will be a discussion of program development, model feasibility, and lessons learned during pilot stages of a 12-discipline, collaborative clinic. Rationale: SCD is the most common genetic disorder among African-Americans in the United States, impacting 73.1 per 1000 African-American births. Importantly, youth with SCD often have comorbid chronic pain and poor access to quality health-care and insurance coverage, which can impact their health-care utilization and functional outcomes. Within this Midwestern Children’s hospital, there has been no predictable process for referring youth with SCD to the PPCIM Department or to teach pain management strategies outside of crisis inpatient consultation. The new Sickle Cell Wellness Clinic, a collaboration of 12 disciplines, provides programming to help youth with SCD normalize daily life by teaching skills to cope with SCD pain, minimize chronic pain development, and improve quality of life through proactive symptom management and wellness. It is critical to examine how disciplines can collaborate to advance service provision for often underserved and at-risk youth with SCD and to discuss how 1 Children’s Hospital has made strides in this area. Objectives: Attendees will be able to list facilitators and barriers that go into planning a collaborative clinic and identify how to increase family buy-in and feedback. (3334) A Novel Nutritional Formulation Containing the Prebiotic Human Milk Oligosaccharide 2′-Fucosyllactose Reduces Gastrointestinal Symptoms and Beneficially Alters the Gut Microbiome in Adults With Gastrointestinal Dysfunction Kirti Salunkhe, MD1, Jennifer J Nikhat Contractor, PhD1 and Ryan, ND, MS2 1Metagenics, Inc., Gig Harbor, Washington 2National University of Natural Medicine, Portland, Oregon Abstract Purpose: Gut dysbiosis, disruption in the homeostasis of the intestinal microbiota, contributes to the pathogenesis of many gastrointestinal disorders. Human milk oligosaccharides, which are naturally occurring in human breast milk, are considered “bifidogenic” and “butyrogenic.” In breast-fed infants, they serve as primary substrates for select Bifidobacterium spp. and are metabolized into butyrate by butyrate-producing gut microbiota. Upper Gastrointestinal Research (UGIR) is a formulation that provides nutritional support for adults with gastrointestinal dysfunction; it contains a combination of essential macro- and micronutrients and prebiotics, including 2′-fucosyllactose (2′FL). This study reports novel data on the effect of 2′FL, in the context of a comprehensive nutritional formulation, in adults with gastrointestinal dysfunction. Results: Twelve participants completed the study. Gastrointestinal Quality of Life Index total score, gastrointestinal symptoms domain, and social function domain scores improved (P < .05). Butyrate, acetate, and total short chain fatty acids (SCFAs) increased (P < .05). Several commensal bacteria increased including Bifidobacterium spp., Bifidobacterium longum, Faecalibacterium prausnitzii, Aneurotruncus colihominis, and Pseudoflavonifractor spp. (P < .05). Conclusions: UGIR consumption was associated with reduced gastrointestinal symptoms, increased fecal SCFAs, increases in several beneficial gut microbes (including species that have been shown to consume 2′FL as a substrate in vitro), increases in butyrate-producing species, and increases in species that have been previously shown to be low in patients with inflammatory bowel syndrome, inflammatory bowel disease, and celiac disease. It is plausible that the improvements in butyrate levels and commensal gut microbiota contributed to the clinical benefits demonstrated on the questionnaire. These results suggest that UGIR is a promising novel nutritional formulation that could be used in the management of gastrointestinal dysfunction associated with gut dysbiosis. (3335) Predicting Osteoporotic Fractures by Bone Mineral Density, Conventional Risk Factors, and Clinical Symptoms for Chinese Community Middle-aged Women Yili Zhang1, Hao Shen2, Junjie Jiang, PhD2, Yan Chai, PhD3, Yanming Xie2 and Xu Wei, PhD3 1Institute of Basic Research in Clinical Medicine, China Academy of Chinese, Beijing, China 2China Academy of Chinese Medical Sciences, Beijing, China 3Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China Abstract Purpose: The aim was to construct an early risk prediction tool for community women aged 40–65 years with osteoporotic fracture in Beijing and Shanghai. Results: Eventually, the Cox univariate analysis showed that major pathogenic factors for osteoporotic fractures were age, whether menopause or not, years of menopause, delivery times, dizziness, lower limb spasm, and bone mineral density (BMD) classification. The Cox’s model was constructed respectively including model 1 (BMD classification plus conventional risk factors and clinical symptoms), model 2 (BMD classification plus conventional risk factors), and model 3 (conventional risk factors plus clinical symptoms). The receiver operating characteristic curve indicated that model 1 had the best prediction accuracy. Conclusions: Based on the relative risk coefficients of various factors at different level of model 1, the early risk prediction tool for osteoporotic fractures of community middle-aged women was initially established. (3337) Wellness in Teaching: A Dynamic Educational Intervention to Improve Faculty Performance Bryan A Lamoreau, MD1, Vicki Sue Rose, MPH1, Amy Hayes, MD1, Christine Segdwick, MD, FACEP, E-RYT1 and Hein, MD1 1Maine Medical Center, Portland, Maine Abstract Overview/Background: Health-care providers’ wellness has been identified as a key quality indicator linked with efficiency and safety. Interaction between providers and patients involves unique interpersonal and emotional demands with potential for emotional exhaustion, depersonalization, and burnout. For providers in an academic setting, there are additional expectations for teaching and research that can add additional stress. Significant attention has been paid to resident physician work hours and burnout, driving very recent Accreditation Council for Graduate Medical Education changes to address well-being. However, there is scarce data for the role of curricula aimed at prevention of burnout in faculty physicians and other teaching clinicians that are often working in direct supervisory roles of learners including residents. This study aims to improve several measures of wellness in this heavily influential group. Program Description: This is a pilot program consisting of 3 modules, each 2 weeks in duration, that will teach and reinforce wellness concepts of flow, mindfulness, and resilience with practical applications to improve teaching effectiveness. Additionally, the program will include regular yoga practice at local yoga studios to reinforce the practical application of these concepts. Pre- and postqualitative surveys and validated scales of these concepts will be used to assess the effects of the program. Conclusion: At this time, curriculum and data collection are ongoing. We postulate that the effects of the Wellness in Teaching program will result in less self-reported stress and burnout and improve wellness as measured on the scales. This may translate to increasing educators’ sense of well-being and teaching self-efficacy as well as their ability to manage the learning environment and establish and maintain supportive relationships with learners. We are hopeful that as a result of our pilot that institutional changes such as the inclusion of regular yoga or other wellness opportunities at our academic center could result. Rationale: Burnout in health-care providers has been a topic of growing interest, especially as evidence of its wide spanning ill effects within a health-care system continues to accumulate. This has driven a growing number of academic centers and health-care organizations to implement strategies to combat burnout and promote wellbeing among providers. This study is unique and important in that it targets attending providers that play a supervisory and teaching role, and thus exert a heavy influence on learners, most notably residents, and medical students. Whether willingly or not these are the role models of our next generation of providers. We foresee the benefit of improving provider wellness as a way to also create an improved experience for both our learners and the patients that interact with our participants. We see our stakeholders as any provider or faculty member within the institution, and we see this pilot program as gathering much needed data to show the wide-reaching benefits of wellness programs such as the Wellness in Teaching program. Wellness programs are associated with lowering health-care costs, reducing absenteeism, achieving higher employee productivity, reducing workers’ compensation and disability-related costs, reducing injuries, and improving employee morale and loyalty. Objectives: Participants will understand the current state of evidence regarding the impact of provider burnout, and conversely well-being, at both the interpersonal and organizational levels; participants will become familiar with validated tools of assessment used in flow, mindfulness, and resilience; and Participants will be able to analyze the results of this study and consider potential applications within his/her own organization. (3343) Cooking Up Health: Assessing the Efficacy of a Culinary Medicine Elective in Medical Students Stephanie Folkens, BA1, Neilé Edens, PhD1, Elaine Cheung, PhD1, Rupa Mahadevan, MD1 and Melinda Ring, MD2 1Chicago, Illinois 2Osher Collaborative for Integrative Medicine, Chicago, Illinois Abstract Purpose: Physicians are the frontline of advising patients on nutrition; however, physicians report feeling ill-prepared to counsel patients on nutrition, and patients often lack the basic skills to make changes to their diet. Only 27% of medical school teach the recommended 25 h of nutrition, and fewer than 14% of practicing physicians feel adequately trained. These findings highlight a need for attention to nutrition in the medical school curriculum. Results: Over the course of the elective, students showed increased confidence in nutrition and obesity counseling (Ps < .002) and improved attitudes about the importance of nutrition counseling in patient care (P = .003). Moreover, students showed increases in their own cooking and nutrition confidence (Ps < .004). We did not find parallel changes in students’ actual cooking or eating behavior (Ps > .47). Conclusions: This study provided preliminary evidence demonstrating the efficacy of a culinary medicine elective for increasing medical students’ confidence in counseling patients in nutrition care and for increasing students’ own cooking and nutrition confidence. Ultimately, this program of research may provide evidence to support widespread integration of the current elective into medical education. (3345) Conducting a Scoping Review on Mind–Body Medicine in Pediatric Oncology Angelica L D'Aiello, BA1 and Jennifer A Lyon, MS, MLIS, AHIP2 1SUNY Stony Brook, Stony Brook, New York 2Children’s Mercy Kansas City, Kansas City, Missouri Abstract Purpose: Scoping reviews represent a valuable technique for assessing the conceptual underpinnings of emerging topic areas, particularly when the topical literature encompasses varying interventions, research techniques, and outcomes. Here, we describe our experience conducting a scoping review of mind–body interventions in pediatric oncology. Results: Both authors individually evaluated every abstract, resulting in 274 conflicts out of 2165 examined. Conflicts were resolved by mutual agreement, resulting in the elimination of 1867 abstracts. Both authors individually screened the remaining 298 full-text articles, mutually resolved 26 conflicts, ending with 74 selected articles. Citation tracking identified 4 additional studies for a final total of 78 included studies. These were iteratively examined, leading to more stringent definitions of exclusion criteria. The final major categories of interventions included “meditation/mindfulness,” “yoga/tai chi,” “massage,” “healing touch/reiki,” “acupuncture,” “art/music therapy,” “virtual reality/advanced technology,” and “complex programs.” Conclusions: The success of a scoping review on emerging fields such as integrative medicine depends on the initial precision of inclusion/exclusion criteria and a willingness to fine-tune those criteria based on the nature of the literature itself. Within the field of pediatric oncology, there is a wide range of mind–body interventions being studied that are imprecisely defined. The scoping review illuminates the need for significantly improved clarity of interventions and outcomes. (3346) Starting a National Consortium for Integrative Medicine and Health: The Dutch Experience Ines von Rosenstiel, MD1, Miek C Jong, PhD2, Rogier Hoenders, MD, PhD3 and Martine Busch, Msc4 1Hagaziekenhuis, Den Haag, the Netherlands 2Mid Sweden University, Sundsvall, Sweden 3Centre for Integrative Psychiatry, Lentis, Groningen, the Netherlands 4Van Praag Institute, Utrecht, the Netherlands Abstract Purpose: Assessing interest in and need for a Dutch consortium for Integrative Medicine and Health to support the worldwide growth of Complementary and Integrative Medicine (CIM) and to guide and improve patient care, research, education, policy and advocacy regarding CIM in the Netherlands. Methods: The Dutch Organisation for Health Research and Development (ZonMw) installed a steering committee to guide 6 pioneering hospitals/research institutes in developing a Dutch consortium. Board members of these organisations and stakeholders from CIM organisations were interviewed about their perceptions, needs and concerns regarding the foundation of a Dutch consortium. Relevant topics were discussed during an invitational conference. American CIM centres were visited and international experts interviewed. The board of the American consortium was consulted. Results: Most Dutch hospitals offer services regarding CIM, however, often without clear procedures or quality standards. There is an urgent need for high-quality research on CIM in the Netherlands, specifically in terms of safety, efficacy and patient outcome. There is also a need for better education and policy making. Facilitators for starting a Dutch consortium are patient demand, new health concepts like positive health, worldwide interest and growth in CIM and support from Dutch medical doctors, researchers and hospital boards with experience in CIM. Barriers are insufficient funding, lack of consensus regarding terminology and framing and influential organisations and doctors that oppose to CIM. All those interviewed stress the need for a Dutch consortium. A founding meeting took place on the first of May 2017 in the presence of board members of the American Consortium. Mission and 5-year strategic plan are now being formulated. Future collaboration with the America consortium was discussed and formalised. Conclusions: A Dutch consortium for Integrative Medicine and Health is feasible and needed. Rationale: The use of CIM is widespread in the Netherlands and the Western world at large. A national survey in the Netherlands demonstrated that almost all Dutch hospitals offer some CIM. However, there is no national research agenda, a lack of national policy regarding the integration of conventional medicine and CIM and a need for better education on CIM. The American consortium has been an essential factor in the growth of CIM, but to further support and facilitate the growth of CIM worldwide, more national consortia are needed. Objectives: Participants will learn about (lessons learned in the Netherlands) the process of starting a national consortium. What are facilitators, pittfalls and barriers? (3355) Is Tai Chi Effective for Treating Osteopenia and Primary Osteoporosis? Grading the Evidence Through Systematic Review and Meta-analysis Yanming Xie1, Xu Wei, PhD2, Junjie Jiang, PhD1, Yili Zhang3, Hao Shen1 and Yan Chai PhD4, 5 1China Academy of Chinese Medical Sciences, Beijing, China 2Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China 3Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China 4University of California, Los Angeles, USA 5Beijing, China Abstract Purpose: The necessity of lifelong treatment and the potential side effects like upper gastrointestinal symptoms hinder pharmacologic treatments for osteoporosis. Tai Chi (TC), one of traditional Chinese exercises without side effects, has proven to be effective in the treatment of many orthopedic diseases. This systematic review was performed to determine the clinical efficacy and safety of TC for osteopenia and primary osteoporosis and provide clear evidence to inform clinical practice. Results: Meta-analysis showed that there was no statistically difference between TC plus conventional treatments (CTs) and CTs on any outcomes. Both in the subgroup that TC versus no intervention and TC versus CTs, there was significant difference on spinal bone mineral density (BMD; 95% confidence interval [CI]: 0.60 to 1.02; 95% CI: 0.09 to 0.23) values, femoral BMD value (95% CI: 0.01 to 0.06; 95% CI: 0.04 to 0.29). Two trials compared TC versus no treatment through the index of quantitative ultrasound but result indicated that TC maybe have a little bit effect only on reducing the SOS (95% CI: 1.28 to 25.76). In addition, 2 trials compared TC plus CTs versus CTs on BGP (95% CI: −1.66 to −0.70), which found a remarkable difference between the 2 groups. Conclusions: There were positive results for TC to benefit for osteopenia and primary osteoporosis. However, the relevant evidence should be interpreted with caution due to the low methodological quality. International methodological and reporting standards could help researchers conduct well-designed trials and improve the level of evidence for Chinese herbal medicine. (3361) Complementary Medicine in Cancer Care: An Observational Retrospective Study on Patients With Cancer at the Hospital of Lucca (Italy) Cristina Noberasco, MD1, Editta Baldini, MD2, Marco Picchi, PsycD1, Mariella Di Stefano, BA1 and Elio G Rossi, MD3 1Tuscan Regional Center for Complementary Medicine, Lucca, Italy 2ASL Toscana North West, Lucca, Italy 3Local Health Unit Tuscany North West of the Region of Tuscany, Lucca, Italy Abstract Purpose: This retrospective observational study describes the results of complementary medicine (CM) treatment to reduce the adverse effects of anticancer treatment and cancer symptoms and improve the quality of life of cancer patients seen at the Clinic for Complementary Medicine and diet in oncology of the hospital of Lucca (Italy). Near all the patients are referred by their medical oncologists. Results: Main type of cancer or localization were breast (56.2%), colon (7.2%), lung (5.4%), ovary (4.2%), stomach (2.7%), prostate (2.5%), uterus (2.7%), brain (1.5%), kidney (1.2%), liver (0.6%), and pancreas (1,1%). Symptoms most frequently treated were adverse effects of anticancer therapies (61.9%), namely, the effects of chemotherapy (37.9%), hormonal therapy (16.3%), surgery (3.2%), and radiotherapy (4.5%). Cancer symptoms were 23.1% and the concomitant symptoms 11.8%. The most frequent symptoms were asthenia/fatigue, hot flashes, depression, neuropathy, nausea/vomiting after chemotherapy, irritable intestine, diarrhea, leucopenia, dermatitis, anxiety, and radiodermitis. Comparing the clinical conditions before and after the treatment, we observed a significant amelioration of nausea (P < .05), insomnia (P < 05), depression (P < .001), anxiety (P < .05), asthenia (P < .001), mucositis (P < .05), hot flashes (P < .001), articular pain (P < .05), dysgeusia (P < .05), and also prevention of radiodermitis (P ≤ .01). Conclusions: A clinic of integrative oncology seems to give the possibility to reduce adverse effects of anticancer therapy and ameliorate the quality of life of cancer patients. (3366) Complementary and Alternative Medicine Visits by Persons With Mental Disorders Across Disorders and Treatment Settings in 29 Countries: Results From the World Mental Health Surveys Peter de Jonge, PhD1, Klaas J Wardenaar, PhD1, Ronald Kessler, PhD2, Viviane K Masfety, PhD3, Sara Evans-Lacko, PhD4, Graham Thornicroft, PhD4 and Rogier Hoenders, MD, PhD5 1Rijksuniversiteit Groningen, Groningen, the Netherlands 2Boston, Massachusetts 3Université Paris Descartes, Paris, France 4King’s College London, London, UK 5Center for Integrative Psychiatry, Lentis, Groningen, the Netherlands Abstract Purpose: A substantial proportion of persons with mental disorders visits complementary and alternative medicine (CAM) professionals, often in conjunction with conventional psychiatric or general medical treatment. However, a data-driven overview of how CAM use varies across countries, mental disorders and their severity, and health-care settings is currently lacking. Results: An estimated 3.6% (standard error [SE] 0.2%) reported visiting a CAM provider, which was 2 times higher in high-income countries (4.6%; SE 0.3%) than in low- to middle-income countries (2.3%; SE 0.2%). CAM visits were largely comparable for different disorder types but particularly high in persons receiving conventional care (8.6%–17.8%). CAM visits increased with increasing mental disorder severity, particularly in those receiving conventional care. Among persons receiving specialist mental health care, CAM visits were reported by 14.0% for severe mood disorders, 16.2% for severe anxiety disorders, and 22.5% for severe behavioral disorders. Conclusions: CAM visits are particularly common in persons with severe mental disorders, in high-income countries, and in persons receiving conventional care. Our findings underscore the need for a coordination of conventional and CAM treatments. (3368) The Pharmacological and Nonpharmacological Treatment of Functional Constipation in Adults: Protocol for an Umbrella Systematic Review and Network-analysis of Randomized Controlled Trials Ying Li1, Xiaohang Yang1, Li Liu1 and Hui Zheng2 1Shaanxi University of Traditional Chinese Medicine, Xianyang, China 2Chengdu University of Traditional Chinese Medicine, Chengdu, China Abstract Purpose: Functional constipation (FC) is one of the most common functional bowel disease associated with substantial socioeconomic loss. Despite several interventions have been tested for their effectiveness in managing FC with randomized controlled trials and systematic reviews, the comparative effectiveness of these interventions remains unclear. Pharmacological and nonpharmacological interventions have not been simultaneously evaluated for comparative effectiveness in treating FC in a systematic review. This limits attempts to make comprehensive inferences to patients, clinician and policy makers. This study will compare the direct and indirect effectiveness and safety of interventions for FC. The findings will offer the opportunity to generate a ranking and assist patient, clinicians, and policy maker to make evidence-based decisions regarding treatment selection. (3372) Reconceptualizing Pain Through Patient-centered Care in the Complementary and Alternative Medicine Therapeutic Relationship Vinita Agarwal, PhD1 1Salisbury University, Salisbury, Maryland Abstract Purpose: To identify pathways for recontextualizing the subjective experience of pain in the integrative provider–patient relationship through an examination of patient discourses of therapeutic management of chronic pain with their complementary and alternative medicine (CAM) providers. Results: The therapeutic relationship utilizes 3 alternative pathways for patient pain self-management of chronic pain through provider assisting alternative patient knowledge positions. First, by listening to the patient’s body, with the provider utilizing intuition to sense what the patient was feeling and to understand what they needed as a person. Second, by connecting the patient’s mind to the body, whereby the provider integrated CAM to connect the patient’s mind to the body by reframing their pain response in alignment with lived experiences. Finally, third by cultivating a self-reflexive therapeutic relationship, whereby the provider encouraged patient self-reflexivity through integrative practices guiding awareness of physiological and cognitive triggers to recontextualize the experience of pain. Conclusions: For integrative providers to assist patients in making evidence-based decisions, there is a need to explicate patient perceptions of the therapeutic relationship to (re)conceptualize models of patient-centered care. The assessment of pain depends on patient perception of and response to pain and pain-related disability. The study suggests integrative provider–patient relationships should emphasize patient–provider interdependence, whereby provider expertise promotes patient mechanisms of listening to their body in collaboration with their patients to connect mind and body for aligning nonpharmacological and biomedical alternatives to support patient long-term self-management of pain. (3373) Punica granatum L. (Pomegranate) Leaves Extract With Potential for Hair Growth Promoting Activity Dheeraj S Randive, MPharm1, Somnath D. Bhinge, PhD1 and Mangesh A. Bhutkar, PhD1 1Rajarambapu College of Pharmacy, Kasegaon, Maharashtra, India Abstract Purpose: In the Indian traditional system of medicine, Punica granatum L. has been used in the treatment of various diseases and found to exhibit high antioxidant, anti-inflammatory, anticarcinogenic, antimicrobial potential, and a wide array of other pharmacological activities. The aim of the present investigation was to explore the effect of alcoholic and aqueous extract of P. granatum L. as hair growth promoter. Results: The hair growth promoting activity of the extracts of P. granatum was observed by studying hair length, hair weight and microscopic study of follicles in vehicle control, and 1% minoxidil-treated and extract-treated animals. The activity was assessed by studying follicle count in the subcutis and skin thickness in vehicle-treated control and extract-treated animals. Conclusions: The findings suggest the hair growth promoting potential of the extract of P. granatum. (3374) Powdered Red Yeast Rice and Plant Stanols and Sterols to Lower Cholesterol—A 5-Year Retrospective Chart Review Joseph S Feuerstein, MD1, Krista M Palmer, BA1, Wendy Bjerke, PhD2, Daniella Lazarus1 and Ella K Feuerstein1 1Stamford, Connecticut 2Sacred Heart University, Fairfield, Connecticut Abstract Purpose: Elevated low-density lipoprotein (LDL) cholesterol is a significant risk factor for cardiovascular disease. It is estimated that 42% of females and 34% of males in the United States have elevated total cholesterol. The current mainstay of lipid-lowering therapy utilizes 3-hydroxy-3-methylglutaryl-coezyme A reductase inhibitor (ie, statin) medications that lower total cholesterol and LDL cholesterol by an average of 20% and 28%, respectively. However, due to the significant side effects of statin medications, many patients seek alternative therapies to help manage their hypercholesterolemia. Red yeast rice (Monascus purpueus) has been used as a food and as an herbal medication in China for centuries. Phytosterols are foods that are similar in structure and function to animal cholesterol. Both of these compounds have been shown in clinical studies to significantly lower LDL cholesterol. An 18 person case series undertaken by the principal investigator (PI; JSF) in April 2012 and published in the Journal of Dietary Supplements using a proprietary blend of 1200 mg of citrinin free red yeast rice (M. purpueus) and 1250 mg of phytosterol complex (sitosterol, campesterol, and stigmasterol) (Natur-lo cholesterol) showed a statistically significant reduction (P < .05) total cholesterol 19% (46 mg/dL) and LDL 33% (53 mg/dL) after 6 weeks of use, without any reports of muscle pain, abnormal liver tests, or any other side effects. Results: One hundred forty patients at the center were prescribed Natur-lo cholesterol during the 5-year period. Seventy-two percent of them were female, and the average age was 62. The average baseline total cholesterol and LDL cholesterol were 248.2 mg/dL (SD 39.3 mg/dL) and 165 mg/dL (SD 33.8 mg/dL), respectively. Of the 140 patients, 86 met inclusion criteria and had followed up with the PI (JSF) in addition to obtaining repeat laboratory testing after 6–8 weeks on the supplement. The average total cholesterol after 6–8 weeks on Natur-lo cholesterol was 196.4 md/dL (SD 34.6 mg/dL), a drop of 20% from the baseline reading. The average LDL cholesterol was 116.2 mg/dL (SD 29.6 mg/dL), a reduction of 29% from the baseline reading over the same period. Paired t tests of mean changes in total cholesterol and LDL were significant (P < .001). No abnormal liver function tests, muscle pains, or other side effects were reported to the PI while using the natural product. Conclusions: In conclusion, this 5-year retrospective chart review reinforces the clinical effectiveness of Natur-lo cholesterol in significantly reducing both total and LDL cholesterol in patients with hyperlipidemia. (3375) “We all have the drug that keeps us moderately functional, but I don’t want to just exist. I want to be better than that”: Interest in and Use of Integrative Health Approaches to Migraine Management in Primary Care Among a Socioeconomically Diverse Patient Group Sharon Hull, MD, MPH1, Justine S de Oliveira, DrPH, PA-C2, Gillian S Schmidler, PhD3, Morris Weinberger, PhD3, Remy Coeytaux, MD, PhD3 and Deanna Befus, PhD4 1Durham, North Carolina 2Barts and The London School of Medicine and Dentistry, London, UK 3Winston Salem, North Carolina 4Wake Forest School of Medicine, Winston Salem, North Carolina Abstract Purpose: Migraine is a highly disabling neurological disorder affecting over 45 million people in the United States. The World Health Organization has declared migraine a major public health problem due to a paucity of knowledge about cause and effective treatment options. Both in incidence and severity, migraine disproportionately affects people occupying low social locations (LSLs). Daily preventive and as-needed abortive medications come with high literal and figurative costs: intolerable side effects, medication interactions, and prohibitive prices. Currently, the available preventive medications are effective in only 50% of patients and 50% of the time. Costly, ineffective, and unsustainable pharmacological treatments have contributed to high levels of interest and use of complementary approaches by people with migraine, but little is known about their usage motivations or patterns. Results: We identified 4 themes: a more holistic, collaborative, long-term treatment approach; medication only as a short-term solution; high personal and economic costs of medication; and desire for more information and access to “alternative” and “natural” approaches. Across social locations, participants expressed keen interest in integrative approaches and wanted better access to complimentary modalities. LSL participants, especially people of color, described heavier reliance on traditional/folk remedies, including family and community healers (eg, “root doctors”), who they described as more affordable and culturally accessible. Conclusions: Integrative approaches were preferred over medication for long-term migraine management. However, people in LSL did not feel as comfortable accessing available integrative approaches. Engaging with LSL communities and using a critical lens to explore barriers to access can develop options to make complimentary modalities more approachable, while attending to systemic blind spots in integrative approaches that may unintentionally alienate socially marginalized groups. (3377) A Systems Thinking Exploration of Women’s Migraine Experiences and Self-management Strategies Deanna Befus, PhD1, Kristen H Lich, PhD2, Shawn Kneipp, PhD, MSN2, Janet Bettger, ScD2, Remy Coeytaux, MD, PhD2 and Janice Humphreys, PhD, MSN2 1Wake Forest School of Medicine, Winston Salem, North Carolina 2Durham, North Carolina Abstract Purpose: Migraine affects over 20% of women and is the sixth most disabling condition worldwide. In incidence and severity, migraine disproportionately disables women occupying low social locations (LSLs). Self-management (SM) behaviors are inextricably linked to social determinants of health and have direct correlations to health outcomes. Yet women in LSLs are often ignored in highly medicalized migraine research, making their SM behaviors and outcomes largely unknown. Results: “Life stressors” was the top trigger across groups, though specific stressors varied by SL. LSL women engaged in more isolating and avoidant SM behaviors. High social locations (HSLs) women used more proactive and integrative approaches and consistently demonstrated more self-efficacy and internal loci of control. LSL women identified concrete SM needs, such as specific objects or environmental requirements (eg, darkness, quiet), while women in HSLs identified personal qualities and behaviors (eg, discipline, memory). LSL women identified reduced pain severity as their most valued outcome, while HSL women valued more opportunities for self-improvement. LSL women had lower expectations for SM, displayed less self-efficacy, used fewer integrative approaches, and were more focused on difficulties of the migraine experience than SM. Conclusions: Traditional migraine treatment metrics (frequency, severity, duration) do not reflect our participants’ most meaningful outcomes. SL proved a useful lens through which to explore women’s experiences, and revealed heterogeneity in SM strategies, priorities, and outcomes. Systems thinking approaches present ways to understand complex health behaviors within the context of multiple overlapping systems influencing choices and experiences. (3378) Indirect Effects of Mindfulness on Empathic Concern and Perspective Taking Through Emotional Awareness Jordan T Quaglia, PhD1, Alison C McLeish, PhD2, Emily M O'Bryan, MA2 and Christina M Luberto, PhD3 1Naropa University, Boulder, Colarado 2University of Cincinnati, Cincinnati, Ohio 3Boston, Massachusetts Abstract Purpose: Empathy (ie, awareness and understanding of others’ emotions) is important for individual and societal well-being, and strategies to enhance empathy are increasingly under investigation. Mindfulness, as a trait and as a practice, is related to greater empathy, but exactly how this intrapersonal practice may give rise to interpersonal empathy remains unclear. Theoretically, improved intrapersonal emotion regulation may support empathy for others, particularly emotional awareness (ie, the ability to notice one’s own emotions) and emotional clarity (ie, the ability to label one’s own emotions). Indeed, mindfulness has been shown to improve emotion regulation, and emotion regulation is related to greater empathy. Thus, emotion regulation may serve as a mechanism underlying the association between mindfulness and empathy. We explored the indirect effect of mindfulness on empathic concern (ie, positive feelings for another) and perspective taking (ie, understanding another’s point of view) through emotional awareness and emotional clarity. Results: There was a significant indirect effect of mindfulness on empathic concern through emotional awareness (b = .11, 95% confidence interval [CI] = .05 to .18; 69% variance) but not emotional clarity (b = .00, 95% CI = −.08 to .06). Similarly, there was a significant indirect effect of mindfulness on perspective taking through emotional awareness (b = .13, 95% CI = .07 to .21; 100% variance) but not emotional clarity (b = −.06, 95% CI = −.13 to .02). Conclusions: An individual’s ability to regulate their own emotions, particularly to notice rather than necessarily understand or label the specific emotion, accounts for most of the relationship between mindfulness and empathy. Research using longitudinal designs is warranted. (3379) Symptoms and Treatment Preferences for Managing Distress Among Acute Coronary Syndrome Patients: Interests in Mindfulness and Electronic Health Approaches Christina M Luberto, PhD1, Gloria Yeh, MD, MPH1, Christopher Celano, MD2, Jeff C Huffman, MD2 and Elyse R. Park, PhD, MPH2 1Boston, Massachusetts 2Massachusetts General Hospital, Boston, Massachusetts Abstract Purpose: Many acute coronary syndrome (ACS) patients experience elevated emotional distress, which increases the risk of cardiac morbidity and mortality. Easily accessible treatments that reduce distress and improve cardiac outcomes are needed. Mindfulness interventions delivered via electronic health (e-health) technologies (eg, texting, videoconferencing) could improve emotional and cardiac outcomes and be easily accessible, but no research has explored ACS patients’ interests in mindfulness and e-health interventions. We therefore explored (1) the specific symptoms which cause distress for ACS patients (physical, cognitive, and emotional) and (2) preferences for treatment (treatment delivery and timing), with a focus on mindfulness and e-health interventions. Results: The most common forms of distress were worry (33%), anger (25%), and sadness (15%). Participants most commonly reported distress due to pain (35%), lack of energy (34%), feeling weak (33%), activity/role limitations (33%), fatigue/sleep problems (32%), and exercise recommendations (29%). Most (67%) were interested in a treatment program for distress. Among those, 73% were interested in a mindfulness intervention specifically, 40% were interested in a group intervention, 86% currently used at least one e-health technology, 68% would use e-health technologies for a treatment program, and 64% felt the best time for treatment was within 6 months post-ACS. Sixty-five percent reported interest in both a mindfulness intervention and e-health approach. Conclusions: ACS patients report a range of distressing symptoms and most would participate in an e-health mindfulness treatment. Mindfulness interventions should be adapted to target ACS patients’ identified needs and preferences and be explored for feasibility and acceptability in controlled trials. (3383) Modified Dialectical Behavior Therapy Skills Training for Emotion Dysregulation: A Naturalistic Practice-based Research Study in a Hospital Setting Julianne G Wilner, BA1, Jessica F Magidson, PhD2, Ellen Prairie, PhD2, Jenn DeSouza, LICSW, CGP2, Michelle Jacobo, PhD2, Harley Rebecca, PhD2 and Christina M Luberto, PhD3 1Boston University, Boston, Massachusetts 2Massachusetts General Hospital, Boston, Massachusetts 3Boston, Massachusetts Abstract Purpose: Dialectical behavior therapy skills training (DBT-ST) is an efficacious mindfulness-based treatment for emotion dysregulation (ie, the inability to effectively regulate emotional distress). Originally developed for individuals with borderline personality disorder, DBT is being increasingly used to treat emotion dysregulation across a range of patient populations and clinical settings. Research on the utilization and effectiveness of DBT-ST for diagnostically heterogeneous patient populations in real-world settings is therefore needed. The aims of this naturalistic practice-based research study are to explore (1) the clinical characteristics of patients who initiate DBT-ST and (2) DBT-ST effectiveness (ie, changes in emotion dysregulation and psychological symptoms). Results: Patients had elevated baseline symptoms of emotion dysregulation (M = 106.41, standard deviation [SD] = 28.18; 56% above the clinical cutoff of 96) and a range of psychiatric diagnoses (61% major depressive disorder; 32% bipolar disorder; 25% generalized anxiety disorder; M = 2.4, SD = 1.0 disorders each). DBT-ST was associated with large and statistically significant improvements in global emotion regulation (ΔM = −16.29; d = .62; P = .01), emotional awareness (ΔM = −1.94; d = .52; P = .02), emotional acceptance (ΔM = −2.89; d = .49; P = .03), access to emotion regulation strategies (ΔM = −5.82; d = .73; P < .001), and symptoms of anxiety (ΔM = −5.59; d = .51; P = .01), depression (ΔM = −6.59; d = .44; P = .03), and borderline personality disorder (ΔM = −4.71; d = .49; P < .001). Conclusions: This exploratory naturalistic study suggests that hospital patients with elevated emotion dysregulation are willing to initiate DBT-ST as part of their clinical care, and DBT-ST can improve emotional outcomes in heterogeneous patients in a real-world setting. Naturalistic studies with larger sample sizes are warranted. (3393) Effects of Joyful Emotion on Pulse-graph Parameters in Healthy Female College Students Based on Emotion-induced Experiments Rong Yuan, MD1, Tianfang Wang, PhD1, Jiayuan Zhang, MD1, Yan Zhao, PhD1 and Yu Wei, MD1 1Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: To explore the effects of joyful emotion on the pulse diagram parameters of healthy female college students. Results: (1) Compared with NT0, all of the pulse diagram parameters in the NT1 had no signficant difference. (2) Compared with JT0, the t1, t2, and t3 in the JT1 were statistically significant and showed a rising trend. (3) Compared each parameter in the NT0 with that of the JT0, there was no statistical difference. Compared each parameter in the NT1 with that of the JT1, the t1 and t2 in the NT0 were significantly higher than that of the NT1, and the other parameters were not statistically different. Conclusions: The pulse diagram parameters t1 and t2 in the JT1 are significantly higher than that of JT0 and NT1, which indicates that the joyful emotion may influence the pulse manifestation by extending the rapid ejection time of left ventricular. (3397) Utilizing Mindfulness With Health-care Professionals to Improve Burnout, Self-compassion, and Patient Quality and Safety Measures: A Comparison of Cardiac Units Anne-Marie Duchemin, MD1, Beth Steinberg, RN, MSN2, Susan Moffatt-Bruce, MD, PhD2 and Maryanna D Klatt, PhD3 1Columbus, Ohio 2Wexner Medical Center, Ohio State University, Columbus, Ohio 3College of Medicine, The Ohio State University, Columbus, Ohio Abstract Purpose: Patient quality and safety outcomes are affected by the ability of the health-care professionals (HCPs) to provide optimal care; stress and burnout can hinder this ability. For instance, nurses’ burnout has been associated with higher rate of patients’ infections. Critical care nurses report high rates of stress and burnout due to organizational factors such as workload demands, limited resources, in addition to individual experiences with direct and secondary traumatic stress, and values conflicts; these concerns are mirrored in interprofessional HCP team members. Results: By intervention end, subscale depersonalization scores (Maslach Burnout Inventory) decreased by 57% (P = .0188) for MIM participants, while controls increased 106% compared to baseline. Stress (measured by Perceived Stress Scale) also significantly decreased in the intervention group to 80% of baseline (P = .0438) while control’s stress increased to 107% compared to baseline. Self-compassion (Self Compassion Scale) demonstrated significant increases postintervention in the intervention group (P < .01) with no changes in the control group. Based on literature reports of average safety event cost estimates/per event, intervention unit baseline (previous year) safety events cost was $506,786, which decreased to $394,019, while control unit estimate went from baseline of $155,019 to $86,768. Conclusions: Research, tying patient safety events with HCP mindfulness training (intended to decrease interprofessional HCP burnout and perceived stress), is possible. This feasibility study indicates that mindfulness programming for HCPs may reduce patient safety events within hospital units. Future studies need to examine the year prior, during, and after the mindfulness training on the unit to accurately assess mindfulness training effect on unit safety events. (3398) Study on Group Psychological Intervention of Subthreshold Depression in Traditional Chinese Medicine Junhui Kong1, Yichunzi Zhang1, Lesley Zhang1 and Xi Tan1 1Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: From yin-yang perspective, as a whole system, Traditional Chinese Medicine (TCM) believes that the subthreshold depression is caused by excessive yin and deficient yang and treated it by the principle of tonifying yang and restricting yin. Many studies have verified that group psychological intervention has great curative effect in the nonpharmacotherapy of depression, but few studies combined with TCM and its characteristic methods of regimen. This paper is to design a group psychological intervention program for people with subthreshold depression from the perspective of tonifying yang and restricting yin in TCM and to evaluate the curative effect of the program. Results: After 8 weeks of intervention, the Center for Epidemiological Studies-Depression (CES-D) score of intervention group (M = 13.17) was lower than before (M = 20.33), t(70) = 14.11, P < .000, and the CES-D score of control group (M = 18.19) was lower than before (M = 21.39), t(70) = 3.30, P < .002, and comparing the CES-D score of preintervention with postintervention, the difference of intervention group (M = 7.17) was more significant than control group (M = 3.19), t(70) = 3.64, P < 0.001. Conclusions: Group psychological intervention program guiding by tonifying yang and restricting yin in TCM can improve the negative emotion of people with subthreshold depression. This study is of important reference value for the intervention of subthreshold depression and preventive treatment of depression. (3400) A New Idea to Cultivate Traditional Chinese Medicine Postgraduates: Combining the Experience Inheritance and Modern Scientific Research Training Liping Zhang1, Xi Tan1, Lesley Zhang1 and Yichunzi Zhang1 1Beijing University of Chinese Medicine, Beijing, China Abstract Overview: Compared with modern medicine, the theoretical basis of Traditional Chinese Medicine (TCM) is totally different, thus the education of TCM postgraduates should not only comply with TCM theoretical system and teaching methods but also take current scientific research into consideration. Based on this, we built a mode of “inheriting experience from TCM teachers-clinical practice training-scientific research training by teachers of life sciences” for TCM postgraduates, in Beijing University of Chinese Medicine, which has been well verified in the education of TCM postgraduates. Rationale: After 5000 years of development in China, TCM has been proved to have good curative effect, while modern scientific researches are more acknowledged. To combine TCM with modern research, we divided education system of TCM postgraduates into 3 parts: cultivating TCM thinking, training clinical practice, and conducting modern life science research. In the part of cultivating TCM thinking, the mode focuses on learning of TCM theories and teacher’s clinical practice experience. In the part of training clinical practice, experienced teachers are necessary in clinical practice bases and TCM hospitals to help students apply their clinical skills to diagnose and treat diseases. In the part of conducting modern life science research, the students should study the theory of modern life science and master the methods of modern research and demonstrate the clinical experience of TCM by the language of modern medicine. This mode could improve the clinical practice ability of postgraduates and promote the development of alternative medicine. Objectives: Influenced by modern concept of science, TCM should develop combined with modern science. In clinical practice, this combination could not only help postgraduates solve problems under guidance of TCM but also explain solutions by means of modern science, and in that way can we develop TCM in modern times. This mode is of important reference value to other alternative medicines. (3401) Information Needs of Pediatric Oncologists in Complementary and Integrative Medicine (CIM)—A Cross-sectional Study Establishing a Blended Learning Program Focusing on CIM Alfred Längler, MD1, Clara C Hilje, BSc2, Tycho Zuzak, MD3, Daniela Reis, MSc2 and Corina Güthlin, PhD4 1Gemeinschaftskrankenhaus Herdecke, University Witten/Herdecke, Herdecke, Witten, Germany 2Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany 3Gemeinschaftskrankenhaus Herdecke, University Hospital Essen, Herdecke, Essen, Germany 4Johann Wolfgang Goethe University, Frankfurt am Main, Germany Abstract Purpose: About one third of all German pediatric patients with cancer use complementary and integrative medicine (CIM); however, pediatric oncologists do not feel particularly confident when discussing CIM-related topics. Only few scientific studies of pediatric oncologists’ information needs in CIM have been conducted. The survey carried out in this study aims to continue to fill this gap. Results: The questionnaire was completed by 101 participants. The age of the participants ranged from 29 to 67. The proportion of women and men was almost equal. Additionally, most participants were senior or chief physicians. More than 70% feel insufficiently informed about CIM, 40% have difficulties obtaining relevant information. Most of them need information about CIM often or occasionally. They stated that they potentially would invest 1 day on average for training. The study revealed that age, professional position, and experience affect the response. Questioned physicians consider an overview of CIM therapies for cancer patients and information about relaxation methods as most important. They were mainly interested in CIM therapies indicated for nausea and vomiting, tumor-related pain, lack of appetite, and fatigue. Conclusions: The study revealed that pediatric oncologists need information on CIM, are very interested in CIM training but have only a limited time frame for advanced training. As a part of the competency network of CIM in oncology (KOKON), we are developing and evaluating a training (e-learning and on-site learning) for pediatric oncologists based on these results. (3404) Characteristics of Registered Acupuncturists, Osteopaths, and Naturopaths in Switzerland Julie Dubois, MA1, Pierre-Yves Rodondi, MD1, Anne-Sylvie Bill, BSc1, Jérôme Pasquier, PhD1 and Silva Keberle, MD2 1Lausanne University Hospital, Lausanne, Switzerland 2Eskamed, Basel, Switzerland Abstract Purpose: More than 20 000 complementary and alternative medicine (CAM) nonphysician therapists are registered in Switzerland. Despite this substantial number, very little is known about the characteristics of these therapists and their practice. The aim of this study was to gain a better understanding of nonphysician licensed therapists in the French speaking part of Switzerland. Results: A total of 426 therapists returned the questionnaire (response rate: 27.5%). Most respondents were women (67.8%) of Swiss nationality (85.1%). The mean age of the respondents was 46.0 (standard deviation [SD] ± 11.6). More than half of participants (56.7%) had a previous training outside the CAM field, especially naturopaths (85.7%). Among those with previous training, more than a half of osteopaths (67.1%) and acupuncturists (57.4%) were trained in a field related to health care while only a fifth (21.7%) of naturopaths were trained. CAM represented the main source of income for a majority of therapists (82.8%), most of them were independent (86.3%) and worked in a single location (77.5%). Naturopaths and acupuncturists mostly worked alone (60.2% and 44.3%, respectively), whereas osteopaths often worked in group practices (56.7%). Length and number of consultations per month varied across therapists: osteopaths performed 117.5 consults/month (SD ± 51.3), lasting 45.5 min each (SD ± 6.5); acupuncturists performed 83.2 consults/month (SD ± 72.9), lasting 61.6 min each (SD ± 12.5); and naturopaths performed 54.3 consults/month (SD ± 57.1), lasting 72.0 min each (SD ± 16.7). Acupuncturists (71.6%) and naturopaths (64.3%) were significantly more favorable than osteopaths (27.7%) to have consultation costs covered by basic health insurances (P < .001). Conclusions: This first study about nonphysician CAM therapists in Switzerland will provide useful information on them and about their role within the health-care system. (3406) Tuina (Therapeutic Massage) for Treatment of Acute Diarrheain Children Under 5 Years Old: A Systematic Review and Meta-analysis Liyan Jia1, Huijuan Cao, PhD2, Ning Liang, PhD2, Rui-xue Hu2, Chun-li Lu2, Sai-nan Fang2, Yajing Zhang2, Jianping Liu, PhD2 and Baoyong Lai2 1Center for Evidence-Based Chiese Medicine, Beijing, China 2Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: To evaluate the effectiveness and safety of tuina (therapeutic massage) as a nonpharmaceutical treatment for acute diarrhea in children under 5 years old. Results: Twenty-nine randomized controlled trials (RCTs) were included involving 3106 children with acute diarrhea. Due to its manipulative nature of tuina, we did not evaluate the participants and operators blinding. All trials did not report allocation concealment and blinding of outcome assessors, the methodological quality of the included RCTs was poor in terms of random method, blinding, and drop out. Compared with the control, the pooled result showed a statistical significantly higher cure rate in the tuina group (risk ratio [RR] 1.61, 95% confidence interval [CI]: 1.41 to 1.84, n = 21 at 3-day treatment; RR 1.68, 95% CI: 1.37 to 2.06, n = 7 at 6-day treatment). Tuina significantly decreased the duration of acute diarrhea (hours; mean difference [MD] −13.82, 95% CI: −16.84 to −10.79, n = 8) and the stool output (frequency/24h; MD −2.02, 95% CI: −2.22 to −1.82, n = 3) compared with control. No adverse events were reported from the included trials in tuina therapy. Conclusions: Tuina seems to be an effective nonpharmaceutical therapy for treatment of acute childhood diarrhea. However, a firm conclusion could not be drawn due to general low methodological quality. Further high-quality trials are needed in the future. (3408) Investigation Into Complementary Medicine Practitioners’ Clinical Experience of Intestinal Permeability: A Cross-sectional Survey Bradley Leech, BHSc1, Janet Schloss, PhD1 and Amie Steel, PhD, ND1, 2 1Endeavour College of Natural Health, Brisbane, Australia 2University of Technology Sydney, Brisbane, Australia Abstract Purpose: Increased intestinal permeability (IP) may play an important role in disease exacerbation and pathogenesis. Through deductive reasoning, complementary medicine (CM) practitioners may have acquired new understanding of IP not yet published within the literature. This study aims to explore the conditions CM practitioners associated with IP and the methods employed to manage IP. Results: CM practitioners (n = 36, response rate 15.9%) associate IP with gastrointestinal (100.0%), autoimmune (91.7%), skin (91.7%), neurological (80.6%), respiratory (55.6%) and liver conditions (44.4%). Observed-associated conditions include food sensitivities (97.2%), intestinal dysbiosis (91.7%), noncoeliac gluten sensitivity (91.7%), bloating (83.3%), rheumatoid arthritis (75.0%), brain fog (65.7%) and inflammation (62.9%). Furthermore, the degree of included conditions was often/always observed to be associated with IP (93.4%). CM practitioners frequently treat IP (72.7%); however, almost never test for IP (58.8%). Patient’s clinical signs and symptoms were the main reasons CM practitioners suspect their patients have IP (94.1%). CM practitioners observe a good (60.6%), major (32.8%) and slight (6.6%) clinical improvement after treating IP in associated conditions. Moreover, conditions with a higher observed association to IP resulted in a major degree of observed clinical improvement after treating IP. Frequently used methods to manage IP include dietary, nutraceutical, and herbal medicine. CM practitioners observe a minimum 3 months of treatment is required to resolve IP with retesting not considered until 6 months of treatment. Conclusions: CM practitioners observe an association between IP and conditions not yet recognised within the published literature. The experience that CM practitioners have obtained through deductive reasoning holds substantial value to the advancement of research and the clinical management of IP. (3411) Yoga for Headache in Adolescents: A Multicenter Randomized Controlled Trial Catharina Amarell, MD1, Melanie Anheyer, MD2, Dania Schumann, MSc3, Gustav Dobos, MD, PhD3, Holger Cramer, PhD3 and Dennis Anheyer, MA3 1Childrens-Hospital St. Marien, Landshut, Germany 2Elisabeth-Hospital, Essen, Germany 3University of Duisburg-Essen, Essen, Germany Abstract Purpose: Previous studies have shown that yoga can be used effectively to prevent and alleviate symptoms in patients with chronic headaches. However, none of these studies examined the effects of yoga on children and adolescents. For this reason, our study aimed to investigate the safety and effectiveness of a yoga program in the treatment of adolescents with chronic headaches. Results: A total of 45 adolescents (81.8% female; 14.6 ± 1.3 years) were randomized to yoga (n = 22) or wait-list control group (n = 23). No significant group difference in headache frequency between yoga and control group was found after 12 weeks of intervention (difference [Δ] = −1.0 days; 95% confidence interval [CI]: −4.4 to 2.4 days; P = .545), whereas the group difference after the 3-month follow-up period was statistically significant (Δ = −4.1 days; 95% CI: −7.7 to −0.5 days; P = .027). None of the secondary outcomes were statistically significant, neither in the short term nor in the long term. Surprisingly, it turned out that parent’s participation in the yoga program even reduced the therapeutic effect. However, this effect showed to be statistically nonsignificant. Conclusions: In line with prior research on adults, it was shown that yoga can also reduce the frequency of headache in adolescents. However, this effect did not become apparent immediately after the intervention but only after a 3-month follow-up period. Moreover, neither headache duration nor pain intensity was significantly influenced by yoga in comparison to the control group. Due to the small number of participants, further studies are needed to verify these results. (3415) How Colored Light Affects the Autonomic Nervous System Activity During a Cognitive Task—Differences Between Blue and Red Light Ursula Wolf, MD Ursula Wolf, MD1, Felix Scholkmann, PhD1, Nassim Nasseri, PhD1 and Hamoon Zohdi1 1University of Bern, Bern, Switzerland Abstract Purpose: In previous studies, we demonstrated that colored light exposure (CLE) evoked specific changes in human brain and body physiology. The aim of this study was to investigate whether CLE has an effect on the autonomic nervous system (ANS) activity during the performance of a cognitive task. Results: We found that the factors “color” and “trial order” were the most significant factors explaining the variance of the data. The type of CLE (red vs blue) determined significantly (F = 511.41, P < .001) the magnitude of the integrated skin conductance response (ISCR). In addition, the order of trials had a significant effect on ISCR as well (F = 122.21, P < .001). The magnitude of the ISCR under the blue light was higher than under the red light exposure (ISCR_blue = 7.95 ± 6.40 log (µS*s), ISCR_red = 5.28 ± 4.44 log (µS*s), t = 4.101, df = 286.0, P < .01). Conclusions: CLE evoked a color dependent effect on ANS activity during performing a cognitive task (verbal fluency task). Blue light was associated with a stronger activity of the sympathetic part of the ANS (increase in ISCR). Our findings are important for future basic research and clinical applications as well as being relevant for everyday life. (3420) Impact of Postoperative Acupuncture on Pain, Nausea, Mood, and Medical Outcomes in Patients Undergoing Valve Surgery: Design and Lessons Learned From the ACU-Heart Pilot Trial Melinda Ring, MD1, Ania Grimone, LAc, CH2, Kim Feingold, PhD2, Judith T Moskowitz, PhD2, Fang Lin, LAc2, Tatyana Shafiro, LAc2, Patrick McCarthy, MD2, Ruchi Patel, BME2 and Charles Davidson, MD2 1Osher Collaborative for Integrative Medicine, Chicago, Illinois 2Chicago, Illinois Abstract Purpose: In addition to pain, nausea, depression, and anxiety, postoperative atrial fibrillation is a common complication after cardiac surgery. ACU-Heart is a randomized controlled pilot trial evaluating daily postoperative acupuncture among patients undergoing valve surgery. Results: ACU-Heart enrollment and intervention are ongoing (N = 70 of 100). The acupuncturists have been successfully trained in delivering treatment within the restrictions of the intensive care environment as well as the need to adhere to the research protocol. Factors that facilitate delivery of daily acupuncture include advanced scheduling and coordination with nursing staff. Retention has been high, with minimal refusals for daily acupuncture sessions. Days of floor transfer and discharge can be more difficult to provide acupuncture given increased demands on the patient. Patients are eager to be randomized to acupuncture and have welcomed the sessions to date. Several patients noted that the acupuncture was the highlight of the hospitalization and surgeons have received positive feedback from patients. Conclusions: This ongoing randomized trial is the first to assess the feasibility and acceptability of delivering daily acupuncture in the hospital setting after open heart surgery. To date, postoperative acupuncture is proving to be both feasible and accepted in the hospital setting, including in cardiac intensive care as early as POD1. (3423) Integrative Clinical Hypnosis and Massage Therapy in Treatment-refractory Chronic Regional Pain Syndrome-I Lindsey McKernan, PhD1 and Taylor Koval, NMT, DT1 1Connecticut Abstract Purpose: Chronic regional pain syndrome (CRPS) is a chronic neurological condition involving the limbs characterized by severe pain along with sensory, autonomic, motor, and trophic impairment. The gold standard of diagnostic criteria varies as do the treatments for the 200 000 cases reported. Multimodal intervention is recommended for CRPS; however, literature supporting integrative interventions is extremely limited. We present a 2-year case study of the integration of weekly massage therapy (MT) and clinical hypnosis in a case of 2-year treatment refractory CRPS of right upper extremity (CRPS-I) diagnosed 5 years after injury. Results: Over the course of 5 months of collaborative hypnosis and MT sessions during his 24-month treatment Patient M showed significant and clinically meaningful decrease in neuropathic pain levels. Goniometric findings (see Figure 1) indicate significant improvements in flexion/distance with the incorporation of self-hypnosis. These results were maintained over a course of approximately 6 months in spite of significant situational stress. Results became less effective as appointments decreased in months 18–24. Conclusions: In a case of treatment-refractory CRPS-I, the integration of fascial MT with clinical hypnosis led to significant and meaningful reductions in neuropathic pain, improved cervical flexion, and TMJ-AP distance. Long-term follow-up indicates that the continued practice and intervention may be required to maintain treatment gains. (3425) Stress Management and Resiliency Training for Health-care Professionals Darshan Mehta, MD, MPH1 and Michelle L Dossett, MD, PhD, MPH1 1Massachusetts General Hospital, Boston, Massachusetts Abstract Purpose: Burnout is epidemic among health-care professionals. Prior studies have suggested that resiliency training programs incorporating mind–body skills may reduce provider burnout. We examined the effects of a stress management and resiliency training (SMART) program developed for clinical populations and adapted it to health-care providers. Results: Participants attended an average of 6 of 8 sessions. There was a significant reduction in perceived stress (P = .001, Cohen’s d = 0.71) and significant improvement in global mental health (P = .018, Cohen’s d = 0.48) as well as nonsignificant trends toward improvement in physical health (Cohen’s d = 0.36) and job satisfaction (Cohen’s d = 0.30). All participants except for one agreed that the program was relevant to their life and that the skills taught were helpful. Qualitative analysis of free text responses revealed that participants developed greater presence with patients, ability to live in the moment, and empowerment to make positive life changes. Conclusions: Delivering the SMART program to health-care professionals is feasible and may serve as a useful tool for increasing resilience to stress. Many participants found the program transformative and the majority felt they benefited from the skills learned. Additional groups are ongoing. (3426) Which Chronic Low Back Pain Patients Respond Favorably to Yoga? Responder Analyses From a Large Randomized Controlled Trial Eric Roseen, DC1, Robert B Saper, MD, MPH1, Anthony Delitto, PT, PhD1, Hanna Karen Sherman, PhD, MPH2 and Gerlovin, MA3 1Pittsburgh, Pennsylvania 2Kaiser Permanente, Seattle, Washington 3Boston, Massachusetts Abstract Purpose: Chronic low back pain (cLBP) is the leading cause of disability worldwide. While yoga has demonstrated effectiveness for cLBP, little guidance exists to help identify patients most likely to benefit from yoga. Results: Sixty participants (48%) were classified as treatment responders. At baseline, treatment responders were more likely to be nonsmokers (P = .004), nonhypertensive (P = .007), and employed (P = .013); have less than daily back pain (P = .002); and believe yoga to be effective for cLBP (P = .013). These 5 characteristics formed the clinical prediction rule which had a sensitivity, specificity, and positive likelihood ratio of 25%, 92%, and 3.1, respectively. Conclusions: Participants who did not smoke, had normal blood pressure, were employed, perceived yoga as effective, and had less than daily back pain were more likely to respond favorably to yoga. However, our findings need to be replicated in a prospective clinical trial with a comparison group. Future analyses of Back to Health should compare the predictive factors of yoga to those of physical therapy and education. (3428) Treating Chronic Pain; the Kairos Model Renee Meyer, MD1 1Primula Internal Medicine, Yonges Island, South Carolina Abstract Overview: In April 2017, the British Medical Journal (BMJ) awarded the Kairos Rehabilitation Centre for its innovative approach to chronic pain. Kairos, a specialty service of the Vanbrugh Community Pain Management Centre in Greenwich, SE London, works with patients with persistent, intractable pain. Most patients have failed to improve at other chronic pain programs. The Kairos center was established in 2009 by Dr David McGavin, a family practitioner who had witnessed benefits to patients with chronic diseases through a multidisciplinary anthropsophic medical approach. In 1991, he helped form the Blackthorn Medical Centre in Maidstone, Kent. At Blackthorn, chronic illnesses as well as general family care are addressed by physicians and other therapists. The Blackthorn Centre was joint winner of the 2001 Prince of Wales’s Foundation for Integrated Medicine Healthcare Award. Together with a therapeutic eurythmy movement specialist and rhythmic massage therapist, the Kairos Rehabilitation team helps patients find and reawaken their own life forces through natural remedies as well as conventional medications, gentle movement exercises, and movement experiences in massage. The therapies aim to restore sleep patterns and lift anxiety in preparation for restoring inner balance. Activities, such as on-site gardening, cooking and singing in a choir, and guiding patients to vocational retraining, support the important area of social reintegration. Patients must agree to be active team members in this process. Kairos rehabilitation has documented significantly decreased depression, improved health status, and decreased analgesic prescription requirements in 29 patients followed at the center. Rationale: Innovative approaches to chronic pain is a central theme of this conference. Chronic pain is a national concern. Objectives: This is a proposed poster presentation. Interested participants will be able to recognize what symptoms commonly accompany chronic pain; appreciate that improving these symptoms may be key to successfully launching further therapy; understand that a multidisciplinary, long-range plan in which the patient must actively participate has been beneficial for chronic pain and other chronic diseases; and acknowledge that adding natural remedies may help decrease use of conventional analgesics. (3429) Integrative Approach Incorporating Acupuncture and Trigger Point Therapy for Occipital Neuralgia Lawrence Taw, MD1 and Rachael M Maciasz, MD1 1Los Angeles, California Abstract Overview/Background: Occipital neuralgia (ON) is a difficult to treat debilitating condition. There is limited data on treatment options, and there is no clear consensus on management. Utilizing trigger point injections and acupuncture may be a safe, efficient, and low-cost approach to treating ON. Program Description: Thiry-eight-year-old man presents with chronic neck and occipital pain for 6 months. Associated symptoms include insomnia, anxiety, and depression. History and physical reveal poor sleep hygiene, family stress, intense weight lifting exercises, hypertension, and tenderness at the left skull base with radiation to the occipital dermatome and left trapezius. Treatment included one session of trigger point injections, acupuncture, and counseling on sleep hygiene and self-care including self-acupressure points, nightly foot massage, and magnesium supplementation. Symptoms resolved after 1 session. Teaching Point: ON is a difficult condition to treat. Current treatments include conservative management, medications with adverse side effect profiles, or invasive procedures including nerve blocks, or neurosurgical intervention. Safe, effective, and low-risk treatment options are needed and may include an integrative approach utilizing acupuncture and trigger point injections. Conclusion: Trigger point injections and acupuncture are low risk, inexpensive, and may be effective treatment of ON. Rationale: ON is a difficult to treat debilitating condition. There is limited data on treatment options, and there is no clear consensus on management. Utilizing and integrative medicine approach incorporating trigger point injections and acupuncture may be a safe, efficient, and low-cost approach to treating ON. Objectives: Participants will have knowledge of an integrative approach to treat occipital neuralgia; participants will know where to locate trigger points associated with occipital neuralgia; and participants will understand acupuncture points that can treat occipital neuralgia. (3431) Evaluating the Effect of Qigong on Cancer-related Fatigue and Quality of Life Cassidy Doucette, DNP1 and Shelley White, MSW1 1Salt Lake City, Utah Abstract Purpose: Examine the effectiveness of Qigong as an intervention to improve and prevent common side effects associated with cancer and cancer care. Results: Twenty-three individuals completed at least 2 Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) questionnaires and 20 individuals submitted their Journal of Experience for review. Results from the PROMIS-29 questionnaires were analyzed using linear-mixed-effect models. Significant improvement was found in 6 of the 8 domains measured. The most dramatic improvements were seen for fatigue (P = .0009) and sleep disruption (P < .0001). Other findings showed significant changes in social functioning (P = .0069), decreased pain interference (P = .0194), decreased pain intensity (P = .0150), and decreased depression (P = .0342). No significant change was seen in physical function (P = .0596) or anxiety (P = .0871). Review of participant experience journals demonstrated that practicing Qigong reduced anxiety and increased a feeling of calm (n = 18), reduced tension (n = 14), reduced pain (n = 10), improved balance (n = 7), improved strength (n = 10), increased mind and body awareness (n = 17), increased breath expansion (n = 17), improved stress management (n = 18), and created a more positive outlook on life and self (n = 15). Conclusions: Incorporating mind–body practices such as Qigong into standard treatment and survivorship plans has the potential to improve quality of life and reduce the physical, emotional, and economic burden of symptom management on individuals with cancer as well as their caregivers. (3432) Compassion Circles and Colored Pencils: Using Expressive Arts as a Tool for Medical Student Self-reflection Lolly Forsythe-Chisolm, BA1 and Delia Chiaramonte, MD1 1Baltimore, Maryland Abstract Overview: The University of Maryland School of Medicine Center for Integrative Medicine offers a biannual elective in Integrative Medicine to senior medical students. Within this elective students engage in diverse self-care and self-awareness activities, including the use of expressive arts. Led by an expert in both mind–body skills and visual art, students explore their values, strengths, weaknesses, and perspectives through the use of art-based activities. The session culminates in an art-based exploration of compassion. After participating in a mindfulness-based imagery experience, students employ the use of visual art as a means of personal exploration. Guided art-based activities are used to allow students to clarify their values, identify their strengths, and explore their weaknesses. Their final activity is the creation of a “compassion circle.” They are instructed to write 3 words or sentences defining their perspective on compassion and then draw a “compassion circle” that expresses this perspective. Over 50 students have created compassion circles and recurrent themes are clear in both the written and artistic expressions of compassion. Written themes include doing for others, forgiveness, lack of judgment, and healing presence. Artistic themes include nature, especially trees, people, hands, eyes, and hearts. This poster will include multiple examples of compassion circles, and the presenters will have others available for participants to review. The poster will include specific instructions for implementing the artistic activities so that viewers can replicate expressive arts activities at their home institution. Rationale: Medical students are at high risk of psychological stress and burnout. Encouraging self-awareness and exploring creativity can be helpful in managing stress and preventing burnout. Therapeutic art can be used to help medical students identify their values and strengths and realistically evaluate their weaknesses. Compassion circles are a tool used to encourage medical students to creatively explore their views on compassion. This poster will provide specific instruction to allow others to replicate this teaching technique. Objectives: The aim is to implement a therapeutic art exercise for medical learners to identify values and strengths, assist medical learners in positively reframing their weaknesses using an art-based activity, and employ the use of compassion circles to enhance self-reflection in medical learners. (3434) Successful Strategies for Overcoming Financial Barriers in Establishing Integrative Oncology Programs Danielle Gentile, PhD1, Chasse Bailey-Dorton, MD, MSPH1, Tara Eaton, PhD1, Beth York, MA, LPC1 and Susan Yaguda, RN, MSN1 1Levine Cancer Institute, Charlotte, North Carolina Abstract Overview: Oncology is a critical field for the development of Integrative Medicine. Integrative oncology (IO) supports cancer patients from diagnosis through survivorship by reducing symptoms, facilitating recovery, and enhancing well-being. However, IO programs remain a rarity in oncology due to financial obstacles in creating them. The purpose of this presentation is to demonstrate practice-proven strategies to reduce financial obstacles associated with IO program establishment through evidence-based and value-driven approaches adaptable across cancer centers. The IO program at Levine Cancer Institute is a success made possible by implementing the following strategies: cost sharing service providers across departments; targeting patients with clinical indications most in need of IO services; purchasing services from independent contractors; training providers in IO approaches throughout care; utilizing trainee healing touch apprentices and kinesiology externs; utilizing community volunteers for therapeutic arts services; cultivating and nurturing philanthropy from individual donors and community fundraising. A 24-h cycling and walking fundraiser has provided nearly $500 000 over 5 years; seeking grant funding for research activities to advance clinical practice; billing insurance for consult visits with an IO fellowship-trained, family medicine physician; and implementing group acupuncture of 5–6 patients rather than costly individual appointments. By implementing these strategies, the IO program provides treatment services (acupuncture, healing touch, massage), integrative classes (nutrition, meditation, yoga, tai chi), a healing arts program (writing, art, music), kinesiology, an IO physician consult clinic, and IO pharmacy consult clinics. These comprehensive services provide value to patients, providers, and the health-care system. It is possible to develop a robust IO program without full insurance reimbursement when dedicated leaders cater to the evidence-based needs of patients, providers, and the system while adopting financial strategies. New and expanded IO programs will advance the IO field by expanding patient access and providing opportunities for scientific inquiry. Rationale: Integrative oncology clinics are a rarity in cancer centers and may be difficult to establish due to financial obstacles. By implementing evidence-based, value-driven strategies appropriate for each cancer center’s unique patients, providers, and goals, it is possible to implement integrative oncology services and expand the reach of integrative services. This abstract relates to the theme of advancing integrative health through clinical practice by demonstrating strategies to make integrative clinical care services practices available to cancer populations. Objectives: Participants will be able to recount strategies for reducing financial obstacles to establishing integrative oncology programs which can be adapted at their home institutions and participants will be able to describe the core components and features of a comprehensive integrative oncology program. (3436) Facilitating Provider–Patient Interdependence in Integrative Medicine for Patient-centered Care: Examining Complementary and Alternative Medicine Therapeutic Relationships Vinita Agarwal, PhD1 1Salisbury University, Salisbury, Maryland Abstract Purpose: The purpose of this study is to inform how integrative providers can set up a patient-centered relationship through facilitating provider–patient interdependence by examining complementary and alternative medicine (CAM) providers’ therapeutic relationship. Results: CAM providers’goal was to encourage openness and relating in an interdependent therapeutic relationship. They presented themselves not as experts within an objective epidemiological encounter but as a partner and guide seen through their own illnesses and spirituality with a goal to increase their patients’ self-management support and positive health outcomes. Conclusions: The body is central to health outcomes. However, biomedical encounters are premised on a disassociation of the provider’s body, its life context, and spirituality to establish an expert provider–patient relationship. Integrative providers seeking to enhance the patient–provider relationship and self-management support can gain insight from CAM providers to cultivate interdependence, openness, and relating by serving as a partner and guide in the patient encounters. (3438) Inpatient Integrative Medicine in the Acute Care Hospital: Impact on Clinical Outcomes and Metrics of Interest to Hospital Administrators Delia Chiaramonte, MD1, Anil Bajnath, MD1, Blaine Guelde, CRNP1 and Donna Audia, RN1 1Baltimore, Maryland Abstract Overview: A collaboration between a medical school-based Center for Integrative Medicine and an acute-care hospital has created a formal inpatient integrative medicine consultation service. Based upon a palliative medicine model, the interprofessional team includes a physician, nurse practitioner, acupuncturist, mind–body specialist/expressive artist, live therapeutic musicians, and several integrative nurses. Services include therapeutic dialogue, guided imagery, acupuncture, acupressure, Reiki, M technique, journaling, therapeutic art, Emotional Freedom Technique, pain management education, live therapeutic music/sound, relaxation breathing, and aromatherapy. We had over 2000 patient contacts last year. Patient feedback is highly positive. Inpatient Integrative Medicine (IM) consultation is provided throughout the hospital and requires a formal physician consultation request. Patients receiving at least 3 IM team visits are offered an anonymous Likert-type scale survey, which is returned to the Center for Integrative Medicine in a sealed envelope. The survey assesses modalities used, effectiveness of the IM team at improving pain, anxiety/stress, and insomnia, satisfaction with overall hospital care, perceived value of the IM service and whether the presence of an IM service would affect hospital choice. Survey collection is ongoing. We hope to assess the overall benefit of the IM service, most effective modalities, and impact of the IM service on patient satisfaction and hospital choice. Preliminary review reveals highly positive results in both clinical and patient satisfaction domains. By May 2018, we will collect at least 100 surveys. Our formal IM consultation service requires a financial commitment from the hospital for uncovered services. Preliminary data will assess not only the effectiveness of the service at relieving patients’ suffering but also assess if providing the service offers benefits of interest to the hospital such as improving patient satisfaction, facilitating JCAHO requirements to provide nonpharmacologic pain management, and potentially increasing market share. Rationale: Formal inpatient integrative medicine consultation may provide physical and psychological benefits to patients coping with serious illness. Convincing hospitals to fund such initiatives will require assessment of the effectiveness of such a service at providing nonpharmacologic pain management, increasing patient satisfaction, and providing unique marketing opportunities. In this session, we will present the mechanics of a well-established inpatient integrative medicine consultation service as well as an initial assessment of clinical benefit and metrics of interest to hospital administrators. Objectives: The aim is to describe a formal inpatient integrative medicine consultation service; discuss the value of an inpatient integrative medicine consultation service to hospital administrators; and replicate an inpatient integrative medicine consultation service at one’s own institution. (3441) Effects of Didgeridoo Sound Meditation on Acute Stress and Mood in Undergraduate Students Kamaira H Philips, BM1, John D Mann, MD1, Susan Gaylord, PhD1 and Carrie Brintz, PhD1 1Chapel Hill, North Carolina Abstract Purpose: Research has shown that meditation is effective for stress reduction in students. Additionally, listening to repetitive sounds often elicits a calming effect. Thus, sound meditation may be effective for reducing stress. Evidence indicates playing didgeridoo (Aboriginal Australian instrument) is therapeutic for sleep apnea. However, psychological effects of experiencing didgeridoo as a form of sound meditation are unknown. We compared the acute effects of didgeridoo sound meditation versus silent meditation on stress and mood in undergraduate students without prior meditation experience. Results: Two-way mixed analyses of variance (ANOVAs) showed that participants in both groups reported significantly decreased acute perceived stress (P < .001, η2 = 0.57), negative arousal (P < .001, η2 = 0.24), decreased energy (P < .001, η2 = 0.22), and tiredness (P < .001, η2 = 0.40). Relaxation significantly increased in both groups (P < 0.001, η2 = 0.46); although the didgeridoo group reported a greater increase in relaxation, the interaction was not significant (P = .06, η2 = 0.05). Fifty-three percent of silent participants and 80% of didgeridoo participants agreed that they would attend that type of meditation again. Conclusions: These data suggest that brief didgeridoo sound meditation is as effective at reducing acute stress and negative affect as silent meditation. The results warrant investigation into didgeridoo as a stress management therapy in students. Future studies should investigate (1) the effects and mechanisms of action of didgeridoo sound in comparison to other types of sounds used in meditation and (2) efficacy of live sounds compared to recorded sounds for sound meditation interventions. (3442) Developing, Integrating, and Implementing Evidence Informed Practice Curricula Throughout a Chinese Medicine Degree Program Roni Evans, DC, MS, PhD1, Paul R Marantz, MD, MPH2, Belinda J Anderson, PhD, MA(Ed)3 and Ben E Kligler, MD, MPH4 1University of Minnesota, Minneapolis, Minnesota 2Albert Einstein College of Medicine, Bronx, New York 3Pacific College of Oriental Medicine, New York, New York 4Mount Sinai Hospital, New York, New York Abstract Purpose: Pacific College of Oriental Medicine (New York) (PCOM-NY) received funding (2013–2018) from the National Institutes of Health/National Center for Complementary and Integrative Health (NCCIH) to train faculty and develop curricula in evidence-informed practice (EIP). The project is being undertaken in collaboration with Albert Einstein College of Medicine, Northwestern Health Sciences University, and the University of Minnesota. This presentation describes the process of developing, integrating, and implementing EIP curricula. Results: Only 5% of PCOM-NY faculty had prior research training. To date, 83% of the PCOM-NY faculty have received EIP training, 42% have undertaken the first section of the online EIP modules (1.3 h), 31% have completed the FEIP course, and 5% have completed all sections of the online EIP modules (10 h). EIP curriculum mapping was completed, and EIP is being integrated into 74% of the master’s degree curricula. EIP course learning outcomes for all courses and clinic activities have been developed, and the department chairs are working with faculty to develop EIP assignments. Issues related to how EIP is defined in conjunction with the nature of available scientific research in Chinese medicine have presented challenges to developing learning outcomes. Conclusions: Training faculty and developing curricula in EIP within Chinese medicine colleges have unique challenges that must be factored into the strategies and process. Having faculty take a leadership role in driving the process greatly facilitates the success of these endeavors. (3443) Dispositional Mindfulness Moderates the Effects of Daily Fluctuation in Negative Affect on Well-being Among Stressed Older Adults Jeff Proulx, PhD1, Dan Klee, BS1, Tab Memmott, BS1, Dana D Colgan, PhD1 and Barry Oken, MD, PhD1 1Portland, Oregon Abstract Purpose: In older adults, dispositional mindfulness has been associated with increased emotional well-being and decreased negative affect. The variability of daily negative affect contains unique information relevant to well-being, beyond that provided by mean negative affect, and has been shown to be salient marker for reduced physical and mental health. To further examine the effects of mindfulness in stressed older adults, this study investigated whether dispositional mindfulness would moderate the relationship between daily fluctuation in negative affect and emotional well-being among older adults. Results: Bivariate correlation analysis revealed a statistically significant inverse relationship between daily fluctuation in negative affect and well-being (r = −.46; P < .001). When controlling for age and gender, the effect of daily fluctuation in negative affect on well-being was moderated by dispositional mindfulness, β = .74, t(108) = 3.60, P < .001. Similar results were found when investigating the interaction effect of dispositional mindfulness and maximum daily negative affect on emotional well-being, β = .52, t(110) = 4.30, P < .001. Conclusions: Research has only recently begun to examine mindfulness in older adults. Results suggest that dispositional mindfulness may decouple the effects of daily fluctuation in negative affect on emotional well-being in a real-time, ambulatory measurement. (3445) Translational Evaluation of a Novel Sulforaphane and Beta-glucans Dietary Supplement on Biomarkers of Detoxification and Inflammation Christopher R D'Adamo, PhD1, Sharis A Erwin, MS2, Grace A Cornblatt, PhD2, Stacy L Ownby, MS2 and Brian S Cornblatt, PhD2 1University of Maryland School of Medicine, Baltimore, Maryland 2Nutramax Laboratories, Edgewood, Maryland Abstract Purpose: Studies suggest increased fruit and vegetable consumption mitigates oxidative stress and chronic inflammation, which have been linked to a variety of health issues. This may be due in part to the presence of phytochemicals like sulforaphane (SFN), derived from broccoli, that modulates oxidative and inflammatory pathways, and the glucans in maitake mushrooms, which support the immune system. While SFN and glucans are potent individually, this study translationally evaluates the cytoprotective and anti-inflammatory properties of the combination of both in vitro and through an ongoing human clinical trial. We assessed the effects of the combination on the expression of biomarkers including the detoxifying enzyme NAD(P)H quinone oxidoreductase 1 (NQO-1), the anti-oxidative enzyme/heat shock protein heme-oxygenase 1 (HMOX-1/HSP32), and the pro-inflammatory markers interleukin-6 (IL-6) and cyclooxygenase-2 (COX-2). Results: The SFN and glucan combination induced the expression of NQO-1 by 2.3-fold (18 h, P < .001), HMOX-1 by 3.5-fold (6 h, P < .001), and decreased IL-6 by 34% (24 h, P < .001), and COX-2 by 28% (24 h, P < .05). Conclusions: While validation in the human clinical trial is pending results expected in early 2018, the preclinical results reveal that the combination offers cytoprotective properties and helps to diminish expression of pro-inflammatory mediators. (3446) The Lower Extremity Contribution of the Vertical Support During Tai Chi Amos Smith, MS1 and Wei Liu, PhD2 1Auburn University, Auburn, Alabama 2Edward Via College of Osteopathic Medicine, Auburn, Alabama Abstract Purpose: Tai Chi (TC) exercise is becoming an increasingly popular complementary and alternative approach for both healthy people and patients with a variety of medical conditions in the United States. TC is a continuous, slow rhythmic, and bipedal movement, and this requires TC to control joints at ankle, knee, and hip in a coordinate manner. The ground reaction force (GRF) is an important indicator of lower extremity synergy of vertical support during walking and running. Few studies have investigated the lower extremity contribution of GRF during TC. To better understand the biomechanics of TC, the purpose of study was to determine the lower extremity contribution of GRF during TC and compared to normal gait. Results: TC was significantly predominated by the contribution of the contralateral ankle (ankle: 32.44%) than normal waking (0.11%), whereas the knee was the primary contributor to support in normal walking (knee: 41.39%) than in TC (17.11%). Conclusions: This study demonstrates that TC places a high mechanical demand on the contralateral ankle joint during vertical support. The lower stress the knee experiences during TC supports benefits of TC on decreasing knee joint load, which suggests TC as a potential therapy for people with joint disease. (3447) The Economic Impact: Optimum Timeline from Behavioral Therapies to Surgical Therapies in Response to Pain CJ Rhoads and DEd1 1Kutztown University, Kutztown, Pennsylvania Abstract Purpose: The purpose of this article is to investigate the financial influences and costs associated with pain management therapies designed for treating patients in chronic pain. Twenty-nine approaches to pain management (including folk, integrative, standard, and surgical) were identified. Each was rank ordered on 5 characteristics: level of invasiveness, duration of expected relief, potential life impact, risk of side effects, and cost. A pain management approach index was calculated based upon the rank orders, and a prioritized list of approaches was developed. The economics of pain management is not a small issue. The Institute of Medicine estimates that pain causes a burden to approximately 100 million U.S. adults, at a cost of at least $560–635 billion annually (not counting people who are institutionalized, or the indirect cost of pain such as loss of productivity). Typically, single pain treatments are less than 50% effective. Pain relief, especially chronic pain relief, is often a matter of multiple treatments rather than a single treatment. Pain management specialists are adept at figuring out what combination of treatments each patient requires based upon the type of pain, duration of pain, as well as both the psychosocial impact and attenuation to pain. This combination is known as the neuromatrix of pain. It is precisely because pain management requires a combination of a multitude of treatments to be fully effective that economic factors are so important. When there are dozens of choices, and multiple treatments necessary to solve the problem, the decision is not simple. Having list of prioritized approaches that takes multiple factors into account should help physicians and patients make better, more informed decisions regarding pain management approaches for acute or chronic pain, regardless of the cause of the pain. Results: The first rank ordering of the methods will be amount of invasiveness. Obviously surgical methods will be more invasive than nonsurgical methods. The results are in the first table (Table 1). The pain management approaches can also be rank ordered by impact on lifestyle and amount of typical pain relief. This can be found in Table 2. The final rank order will be by cost of procedure (Table 3). Given the discussion previously on the difficulties of analyzing economics, and the myriad of choices regarding the items, it was decided to look up the codes for each procedure in a consumer-lookup site (http://fairhealthconsumer.org/). When the procedure was not available, a fair sample (3–5) of instances of the costs were searched on the World Wide Web and utilized. When possible, the cost to the patient, the cost to the insurance company, and the cost to Medicare were recorded. Based upon these myriad of costs, an assessment was made that enabled the procedures to be rank ordered based upon their 5-year cost. Because some of the costs are ongoing (such as massage therapy, mind–body therapies, etc.) and dose-specific, the typical number of times the therapy would be paid for was utilized to rank order. For example, a Pilates, Yoga, or Tai Chi class would typically be held 2 times per week, whereas a massage was more typically done 1 time per week. Surgery would typically be counted only once, except in the cases where a battery would need to be replaced; the cost would include 1 additional surgery for that purpose. In addition to the rank order of the cost, whether or not there is potential for negative side effects must be taken into account. For each approach listed, in addition to the rank order of the cost, the assessment for potential negative side effects has been listed (Table 3). Small, medium, and high are relative assessments for negative, unwanted side effects. When the possibility of negative side effects was nonexistent, and there was no potential for positive side effects either, the table indicates none. If there was potential for positive side effects, such as the case of physical/behavioral therapy or cognitive behavioral therapy (CBT) or mind/body practices improving one's overall health, relationships, or quality of life, then the assessment was positive. Conclusions: Due to the limitations of this study, it might be considered simply a starting point for further study. One of the difficulties in treatment, however, is the fact that practitioners generally come from only 1 of the categories. In other words, those who tend to prescribe analgesics are more likely to be primary care physicians and those who perform surgery are likely to be orthopedic or neurological surgeons. Those who work in the integrative medicine world are likely not part of the official health networks at all, and folk medicine or home remedies often have no specific advisor for the patient except for articles in the popular press and websites such as The People’s Pharmacy (www.peoplespharmacy.com). Nonetheless, the results, which include both economic and noneconomic factors, provide some practical clinical guidelines for treatment. The pain management approach to which patients are directed, therefore, is generally a foregone conclusion based upon who they see. If they go to a healer, they will get folk medicine. If they go to a chiropractor, they will get an adjustment. If they go to a primary care physician, they will get analgesics, and if they go to a surgeon, they will get surgery. In a perfect world, the primary care physician would take the responsibility to direct the pain management options and would include low-cost folk medicine and integrative medicine in the continuum of care. Because many primary care physicians are not prepared or trained to do that, pain management specialists have cropped up, at a higher specialty cost, in order to direct the care with multidisciplinary approach. Though they generally include more options such as CBT or physical therapy, even they don’t include the whole gamut of options for pain management. Except for those on the cutting edge of pain relief, you will not generally see doctors recommend Tai Chi, yoga, pilates, meditation, or nutrition therapy for pain management despite the fact that past anecdotal evidence is strong and now there is growing scientific evidence as well. Furthermore, for some of the treatment options (especially integrative medical therapies), there is still, however, difficulty in control. Patients could chew willow bark instead of going to the store aspirin, but the dosage would be wildly variable, perhaps causing more problems than it solves. There are few controls, or even guidance, as to mind/body or meditative practices. How often is enough? How long must sessions be? Who is qualified to teach the patient how to do it? These are all valid questions that currently have no standard answer. From a society perspective, and from the patients perspective, it is beneficial to try folk and integrative medicine before jumping to standard care. Standards of care generally rely upon the patient to try home remedies, exercise, and nutrition before coming to the doctor with a complain of pain, but often patients have not done so, don’t understand how powerful simple remedies might be, and are not willing to try something on their own without the blessing of the physician. Finally, patients themselves must be relied upon to carry out the treatments. Exercise, for example, is generally accepted as being highly effective in a pain management program (as well as many other metabolic maladies). Dosage is even relatively well established scientifically; it is known that 20–60 min a day of medium-intensive repetitive exercise such as walking is generally required to make a difference. But other than telling that to the patient, the standard medical practice does not have a system of coaching to help, support, and encourage patients to exercise daily. As a result, it goes unused as part of the pain management program despite its effectiveness. While this study is only a start, and has many limitations, it does do 1 thing that most studies do not; it brings together different pain management approaches from many different areas (folk, integrative, standard, and surgical) in order to provide a more complete view of the options. Therefore, despite its limitations, and with the recognition that not all pain management approaches would be appropriate for all sorts of pain, a list was compiled that provides guidelines for the order in which each of the approaches should be utilized (before giving up on it as not effective). These approaches are not mutually exclusive, and it is not a waterfall list. In other words, many approaches (perhaps even dozens) should be tried simultaneously, and those that don’t appear effective after a sincere effort and several months of trial should be dropped. Some of the remedies should only be utilized for a short time (such as analgesics of any sort) due to the fact that side effects increase dramatically as the approach extends in duration. Other remedies, especially the integrative medicine approaches, CBT/acceptance and commitment therapy and physical/behavioral therapies should be used for at least 6 months before giving up, especially if the pain is not so severe as to require stronger approaches. It should also be kept in mind that some approaches such as opioids or surgery often result in increased pain in the long run. While the patients themselves should be the ultimate deciders on the order and duration of the different approaches, it behooves either the primary care physician or the pain management specialist to present all the approaches, their advantages and their disadvantages, rather than just the standard approaches. The patients should be more fully informed regarding costs and side effects of all the different approaches. This list takes into account all of the different rank orders; side effects, life impact, typical pain relief, level of invasiveness, and, finally, cost. The impact of side effects was given a number value between 1 and 5 equivalent to the potential impact: positive 1, none 2, small 3, medium 4, and high 5. The index was calculated by taking the rank orders of each of the factors and adding them together, times the potential impact of side effects, which provided the final rank order by priority of pain management approach seen in Table 4. Though subjective in nature, and only a beginning, the information provided in this study can help physicians and patients impact the economics and effectiveness of pain management. Both practitioners and patients benefit from knowledge of all the various approaches to pain management (folk, integrative, standard, and surgical) and from an understanding of the advantages and disadvantages of each on 5 characteristics: level of invasiveness, duration of expected relief, potential life impact, risk of side effects, and cost. Reviewing this information will help physicians and patients make better decisions with more positive outcomes at lower cost. The analysis shows that more focus and higher priority should be placed on approaches with low incidence of side effects (or positive side effects) such as mind/body practices, biofeedback/meditation, massage therapy, physical/behavioral therapy, and CBT. Scientific evidence of the effectiveness of these approaches in pain management is strong and growing. Physicians are urged to become familiar with the whole gamut of pain management therapies and to direct their patients to try multiple therapies in optimized order before resorting to therapies with more side effects such as opioids and surgery. (3448) Yoga: Theory and Practice: A Course Illustrating Yoga Belongs in the Academy Maryanna D Klatt, PhD1 1College of Medicine, The Ohio State University, Columbus, Ohio Abstract Overview: The course “Yoga: Theory and Practice” (YTP) evolved from the realization that graduate and undergraduate academic offerings of yoga courses were filled beyond capacity with long waitlists, while students were missing the depth and breadth of what yoga has to offer as an integrative health practice. Students experientially understood the contribution yoga practice (asanas, breathing, and meditation) made in their lives, and sensed the health benefits it afforded. Yet, they were hungry for the scientific evidence behind yoga for various clinical conditions. Students wanted scientific evidence for what they experientially knew to be true—yoga helped them feel more grounded in their bodies, more like themselves. In 2004, college yoga courses were typically in Departments of Physical Education, there was no educational literature on how to design a course that would give students the knowledge they desired, and the theory behind why yoga was practiced was slim to nonexistent in yoga courses offered. This is no longer the case. YTP is a course within an academic minor of study, “Integrative Approaches to Health and Wellness” at one of the largest universities in America. Salient features of the course include (1) philosophical exploration of the difference between reductionism and wholism as applied to health, (2) theoretical/historical background of yoga and Ayurveda, (3) scientific and experiential benefits of mindfulness/meditation, and (4) scientific evidence that has emerged on the health benefits of yoga for specific conditions. YTP provides students with the historical, philosophical, and integrative health benefits that yoga has to offer. Utilizing the text, The Principles and Practice of Yoga in Health Care (Khalsa, Cohen, McCall, & Telles, 2016) provides the evidence detailing the scientific study of yoga. All 4 of the salient features of the course inform the practice of yoga within YTP. Yoga belongs in the academy! Rationale: Course design is not an easy task, but course design bridging paradigms is nearly (but not quite!) impossible. The course design of YTP was implemented in 2004 and is a thriving course in today’s academy—one of the largest universities in America. This educational abstract definitely advances integrative health through research and education, giving these students (our leaders of tomorrow) the means to implement yoga into their lives and careers. Many of the students over the years who have taken this course were pre health-care professionals. Today, those students are practicing health-care professionals, hopefully utilizing yoga in their practice. Enrolled in this course, they were enriched with the history, philosophy, and scientific background necessary to utilize these concepts in their medical practice. Curriculum design is vitally important in advancing cultural change, and YTP has been an important, innovative part of that movement. Objectives: As a result of this session, participants will be able to detail how the course design of a yoga college course is integral to the content one is trying to convey; explicate the 4 essential components of YTP as they relate to advancing integrative health through research and education; and design their own college course back at their home university utilizing the 4 essential elements described in this session. (3450) Where East Meets West: Integrative Medicine and Health at Mayo Clinic in Florida Dawn M Mussallem, DO1, Michelle A Leak, DEd, MBA1, Melissa B Smith1, Carol Ann O Schwartz, RN, BSN1, Ingram Caswell1, Tony E Hanneken1, Mark A Mihaly1 and Troy R Delaney, MBA1 1Jacksonville, Florida Abstract Overview: Noting the limited availability of Integrative Medicine and Health (IMH) programs at academic medical centers in the Southeast United States, Mayo Clinic in Florida (MCF) conducted a 4-month (March 1–June 30, 2017) pilot among outpatients with breast cancer offering acupuncture, massage, functional nutrition, mindfulness and resiliency, integrative medicine MD consults, and botanicals and supplements consults in an effort to help patients manage unresolved symptoms and/or the potentially debilitating adverse effects of conventional cancer treatment. The pilot was extended to include massage therapy for neurology and neurosurgery inpatients. The pilot was designed to (1) identify and/or confirm any benefits of integrative medicine therapies to patients, (2) assess patient demand or interest in integrative medicine therapies, (3) assess the financial implications of integrative medicine therapies for patients and providers, and (4) assess clinical practice models specific to integrative medicine therapies. Patients completed the Breast Cancer Prevention Trial Quality of Life Survey. In addition, patients were asked to complete a survey specific to their interactions with IMH providers. Patient satisfaction results totaled 100%—“very good” (93% minimum) plus “good.” IMH therapies were utilized by over 90% of newly diagnosed breast cancer patients and a wait list currently exits for IMH consults. With respect to neurology and neurosurgery inpatients, the massage therapist documented patients’ self-reported pain scores before and after providing massage therapy. On average, patients reported a 60% improvement in their level of pain after massage therapy. The IMH pilot achieved a 36.9% operating margin reflecting allowances for customary expense reductions. Recognition of revenue reductions resulted in a 8.2% operating margin. Pilot results revealed opportunities specific to availability of consult slots and exam rooms, use of supplemental staff, billing and reimbursement, “no-show” policy development, ordering processes, and post discharge follow-up and tracking. Efforts are currently underway to offer IMH therapies to all MCF patients. Rationale: The IMH pilot at MCF highlights collaborative opportunities for health-care consumers, IMH practitioners and administrators, policy makers, and insurers. Consumer out-of-pocket expenditures for integrative medicine therapies now total over $34 billion annually. While an increasing number of hospitals now offer integrative medicine therapies, reimbursement for integrative medicine lags behind reimbursement for more traditional and invasive therapies and treatment modalities. Consumers and IMH practitioners and administrators have the opportunity to influence policy makers and insurers based on their individual and collective experiences utilizing and designing IMH services. More specifically, consumers can speak to the benefits of integrative medicine, as IMH reaffirms the importance of the relationships between practitioner and patient, focuses on the whole person, and makes use of all appropriate therapeutic approaches for health and healing. IMH practitioners and administrators have the opportunity to ensure that IMH services and therapies offered are informed by evidence, driven by inquiry, and open to new paradigms. Policy makers and insurers have the opportunity to act upon the evidence and in so doing expand health-care reform to include reimbursement for less costly and invasive treatment modalities and therapies while adding value—a measure of cost and quality—to an increasingly overburdened and inefficient health-care system. Objectives: As a result of this session, participants will gain insights into how to design, implement, and manage a financially viable IMH program; engage providers and practitioners across clinical disciplines; and anticipate and proactively address patient expectations specific to billing and reimbursement for integrative medicine therapies. To fully present this topic, submitting author requests consideration of powerepoint presentation (not poster presentation). Thank you. (3451) Maoto, Traditional Kampo Formula, for Influenza: A Systematic Review and Meta-analysis Ryutaro Arita, MD1, Yuko Horiba, MD1, Kenji Watanabe, MD, PhD1 and Tetsuhiro Yoshino, MD, PhD1 1Keio University School of Medicine, Shinjuku, Tokyo, Japan Abstract Purpose: Influenza is common viral infection all over the world, and it causes general symptoms, including fever, headache, malaise, and cough. Traditional Kampo formula, maoto, has been used traditionally for the treatment of acute febrile disease. In the Japanese national health insurance system, the influenza is one of the indications of maoto. However, there has been no meta-analysis of maoto for the treatment of influenza. Here, we performed a systematic review and meta-analysis to clarify the efficacy and tolerability of maoto (ma-huang-tang) for the treatment of influenza. Results: Twelve relevant studies (total n = 1248) were identified including 3 randomized clinical trials (RCT) and 9 non-RCTs. The duration of fever did not differ between maoto and neuraminidase inhibitor (NI). Maoto plus NI was superior to NI alone in terms of the duration of fever (P = .002, weighted mean difference = −5.41 h, I2 = 0%). There was no severe side effect reported from maoto nor NI. Conclusions: Our result suggests that maoto has a beneficial effect on the duration of fever when it is used solely or additionally to NI, and maoto seems to be a well-tolerated treatment. The quality of evidence for this finding, however, was low because of a high risk of bias. More RCTs are needed to determine the efficacy and safety of maoto. (3452) Entry-level Massage Education’s Preparation for U.S. Health-care Settings: Perspectives From Experienced Massage Therapists Ann Blair Kennedy, DrPH, LMT, BCTMB1, Arash Zakeresfahani2, Angela Weaver Barker, BCTMB, LMT, AMTA3, Troy Lavigne, LMT, CKTI, CPMT, AMTA4, William Dunn, BA, LMBT5 and Niki Munk, PhD, LMT2 1University of South Carolina School of Medicine Greenville, Greenville, South Carolina 2Indiana University School of Health and Rehabilitation Sciences, Indianapolis, Indiana 3Milton, West Virginia 4Healthcare Operational Committee, Boulder, Colorado 5Greenville Technical College, Greenville, South Carolina Abstract Purpose: Massage therapists work in a variety of settings including health-care centers (organization, business, or institute providing preventative and/or medical care services). Little research focuses on massage therapists’ experience working in U.S. health-care centers, and reliable data are needed to understand existing educational preparation and to better inform educators and practitioners for increasing health-care integration opportunities. Results: N = 386 surveys were completed and analyzed for all and by medical setting experience (defined as in/out patient medical clinic, hospital, doctor’s office, or nursing home). A majority of respondents were White (85%), female (88%), and state licensed/equivalent (94%). Forty-seven percent reported medical setting massage experience. Smaller proportions of therapists under 40 worked in medical care settings (34%; P < .01) compared to those aged 40–59 years (51%) and 60+ (57%). A majority of respondents (80%) indicated education beyond entry-level training was needed for massage therapists working in health-care centers, but proportions were smaller among those not working in a medical care environment (74% vs 87%; P = .0014). Those whose health-care center work as a massage therapist were in medical care environments reported reliance on experience from other related fields in greater proportions (73% vs 59%; P = .003) and did not feel as strongly that their entry-level massage training prepared them for work in health-care centers. Conclusions: Different experiences and medical team involvement based on health-care center setting type may influence massage therapists’ education needs and perceptions. (3453) A Multidisciplinary Approach to the Development of a Rational Phytotherapeutic From Centella Asiatica Maya Caruso, BS1, Kirsten Wright, ND, MS1, Nora Gray, PhD1, Donald G Matthews, PhD1, Armando Alcazar Magana, PhD2, Charles Murchison, MS1, Amala Soumyanath, PhD1, Jan F Stevens, PhD2, Claudia S Maier, PhD2, Joseph Quinn, MD3, Jonathan Zweig, BS1, Jennifer Zhu, BA1, Christopher Harris, BS1, Parnian Lak, PhD2, Doris Kretzschmar, PhD1 and Margeux Hunter, BA1 1Portland, Oregon 2Oregon State University, Corvallis, Oregon 3Portland VA Medical Center, Oregon Health and Science University, Portland, Oregon Abstract Purpose: Alzheimer’s disease (AD) is a debilitating form of dementia with a high global burden and need for effective treatments. Centella asiatica (CA) is a botanical from Eastern medicine reputed to enhance cognition. Previous studies on CA and its bioactive components in preclinical models strongly support its potential as a phytotherapeutic for cognitive decline and AD. The development of effective and reproducible phytotherapeutics warrants a plethora of specialized skills due to the complexity and variability of botanical extracts. We will present our approach to the development of a rational phytotherapeutic from CA for future examination in clinical trials of AD. Results: Aqueous CA extracts improve cognitive function in mouse and Drosophila models of aging and AD. This may be due to influences on the antioxidant response, mitochondrial activity, tau phosphorylation, and synaptic density. Sensitive liquid chromatography coupled to mass spectrometry methods have been developed to fingerprint CA extracts and measure biologically active compounds (triterpenes and caffeoylquinic acids) in biological matrices. These bioactives have been found to be bioavailable in rodents allowing for the use of interspecies scaling in determining doses for future translational studies in humans. Conclusions: A multidisciplinary approach is essential to the development of rational phytotherapeutics. Our methodology is an example of a robust scientific approach to developing a phytotherapeutic for examination in AD. (3462) Treatment Plan as a Significant Predictor of Appointment Scheduling in Acupuncture Patients Chun Nok Lam, MPH1, David S Black, PhD1, Sang Hyun Lee, Lac2 and Chris Ruth, LAc, DAOM2 1Los Angeles, California 2Emperor’s College of Traditional Oriental Medicine, Santa Monica, California Abstract Purpose: Clinical factors that influence a patient’s decision to continue acupuncture treatment after initial consultation are not known. This study tests the effect of having a clinical treatment plan on patients to schedule a follow-up appointment after their initial consultation. Results: The study analysis included 120 participants (age: M = 42.6 ± 13.0 years, 27.5% male). About two thirds (62.5%) received a treatment plan recommending follow-up visits, and 55.8% reported scheduling an appointment prior to leaving the clinic. Treatment plan and appointment scheduling were correlated (rho = 0.32, P < .001); 68.0% of participants with a treatment plan scheduled an appointment while only 35.6% without treatment plan scheduled (P < .001). Adjusted regression analysis showed that having a treatment plan (odds ratio [OR] = 3.06, 95% confidence interval [CI]: 1.26, 7.41, P = .013) and intention to follow-up (OR = 2.09, 95% CI: 1.15, 3.77, P = .015) increased the likelihood of appointment scheduling. Other covariates including age, sex, illness perception, level of disability, chronic illness, immediate symptom improvement, attitude toward integrative therapies, acupuncture expectancy, and patient–provider relationship did not predict appointment scheduling. Conclusions: Appointment scheduling reflects a patient’s decision to continue care with acupuncture. Treatment plans serve a key role in offering patients guidance for future actions and can potentially lead to improved adherence to treatment recommendation. Acupuncturists can help patients benefit from ongoing treatment by establishing a treatment plan as part of their routine clinical procedure. (3463) Insight From the Experts: A Qualitative Study to Assess Definitions, Outcomes, and the Process and Practice of Mindfulness Michael Christopher, PhD1, Josh Kaplan, MS1, Cindy Marino, PsyD1, Varinthorn Christopher, MFA1, Sukjai Charoensuk, PhD2, Penphan Pitaksongkram, PhD2 and Dana Dharmakaya Colgan, PhD3 1Pacific University, Forest Grove, Oregon 2Boromarajonani College, Chon Buri, Thailand 3Portland, Oregon Abstract Purpose: Eastern and Western perspectives on mindfulness share an overarching intention to alleviate suffering, and there is significant overlap in their methodologies. However, there are also differences in the conceptualization of mindfulness in Buddhism and Western science, which may have important implications for treatment delivery, assessment procedures, and optimal clinical outcomes of secular mindfulness-based interventions (MBIs). This qualitative study was designed to ascertain culturally grounded, expert information on mindfulness from Buddhist monks, nuns, and lay practitioners recruited from Zen, Tibetan, and Theravada Buddhist temples in the United States and Thailand. Results: The data revealed prominent distinctions between the process/practice and outcomes of mindfulness. Key processes included clear comprehension, 4 foundations of mindfulness, receptive awareness, deliberate focus of attention, and returning to present moment. Key outcomes included wisdom, joy, interpersonal positivity, spaciousness, calm mind, and equanimity. Participants also identified Buddhist concepts deemed essential to the cultivation of well-being that have received little attention in MBIs (eg, ethical living, impermanence of all phenomena). Conclusions: Understanding mechanisms and outcomes of mindfulness from a Buddhist perspective has the potential to inform MBI development, enhance mindfulness assessment, and optimize clinical outcomes. (3464) Recovery of Centella Asiatica Bioactives From Plasma: Method Development and Application to a Pharmacokinetic Study Maya Caruso, BS1, Kirsten Wright, ND, MS1, Margeux Hunter, BA1, Joseph Quinn, MD2, Amala Soumyanath, PhD1, Charles Murchison, MS1, Donald G Matthews, PhD1 and Nora Gray, PhD1 1Portland, Oregon 2Portland VA Medical Center, Oregon Health and Science University, Portland, Oregon Abstract Purpose: Centella asiatica (CA) is an Eastern medicine botanical believed to enhance memory. Aqueous extracts (200–300 mg/kg/day) containing triterpenes (0.94%–2.41%) and caffeoylquinic acids (CQAs; 0.01%–0.46%) improve cognition in several rodent models. Mouse models for translational studies present a challenge due to low plasma yields. This study evaluated different plasma work up methods to recover CA’s chemically divergent compounds and detect them with sensitive liquid chromatography-tandem mass spectrometry. This methodology was applied to a pharmacokinetic (PK) study in mice. Results: Phree columns were effective for the CQAs and C8 columns were effective for the triterpenes. Protein precipitation with methanol:acetonitrile 1:3 gave good linearity (r 2 = .907 to .999) and precision (3% to 16% relative standard deviation) for both the triterpenes and CQAs. In the PK study, maximum plasma concentrations (Cmax) of CQAs and metabolites (10–125 ng/mL) occurred within 60 min, whereas triterpenes did not peak within 4 h. Conclusions: Protein precipitation with methanol:acetonitrile 1:3 is the preferred method for recovery of CA analytes from small volumes of mouse plasma. CQAs from CA water extract are orally bioavailable and metabolized. These methods will be translated to future human studies. (3465) First Timers Versus Repeat Users of Acupuncture: Differences in Perceived Illness Severity, Treatment Appraisal and Intention for Follow-up Treatment Adam Burke, PhD, MPH, LAc1, Eileen Jia, LAc2, David S Black, PhD3 and Chun Nok Lam, MPH3 1San Francisco State University, San Francisco, California 2Emperor’s College of Traditional Oriental Medicine, Santa Monica, California 3Los Angeles, California Abstract Purpose: This study aims to test for potential differences between first timers and repeat users of acupuncture on key factors related to acupuncture utilization. Results: The study analysis included 120 participants (age: M = 42.6 ± 13.0 years, 27.5% male). Participants were predominantly white (72.5%), well-educated (70.8% 4-year graduate), and had health insurance (90.8%). Thirty-three participants (27.5%) were first timers. First timers were more likely to be male (48.5% vs 19.5%, P = .002) with less education (48.5% vs 79.3% 4-year graduate) compared to repeat users. First timers reported higher illness perception (M = 46.1 vs 41.1, P = .001), appraised acupuncture as less effective (M = 2.1 vs 3.2, P < .001) and had a less positive attitude toward integrative therapies in general (M = 17.5 vs 20.8, P < .001). Both groups reported a similar level of intention to return for follow-up treatment visits (M = 3.5 vs 3.5) and complete the recommended treatment course (M = 3.5 vs 3.7). Conclusions: First-time acupuncture users reported higher illness severity and lower positive appraisals than repeat users. Notably, these disparities did not affect first timers’ intention to continue care with acupuncture for the same health condition. Our findings inform acupuncturists to specifically address concerns over first timers’ heightened illness perception and provide additional information on existing evidence for integrative therapies. (3466) Anti-inflammatory Bowel Disease Effects of Dietary Chitin in Both Sexes Patricia Louis, MS1, Janet Menzie, PhD1, Zhongwei Li, PhD1, Minoru Koi, PhD2, C Kathleen Dorey, PhD3, Changlong Nan, PhD1 and Yoshimi Shibata, PhD1 1Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida 2Ann Arbor, Michigan 3Virginia Tech Carilion School of Medicine and Research Institute, Roanoke, Virginia Abstract Inflammatory bowel disease (IBD) is a chronic relapsing colitis, associated with risk for obstruction, fistula and colorectal cancer. IBD is probably caused by immunologically dysregulated host and microbial interactions. The prevalence of IBD has been increased significantly over the last decades in the US. Women with IBD were found to suffer from adverse effects of anti-inflammatory agents more often than men; therefore, new treatment strategies for both sexes are needed. Chitin is natural N-acetyl glucosamine polymer, existing in fungi and crustaceans but not in mammals or bacteria. Chitin is purified from wastes of seafood industry. Various forms of chitin and its derivatives including drug delivery nanoparticles are muco-adhesive. Although use of chitin products for IBD treatment has be reported by many groups, there are no comparative studies among chitin products or between males and females. Previously, we found that chitin microparticles (1 -- 10 μm diameters, CMPs) induce phagocytosis-dependent and CD14-mediated macrophage activation. Using mouse models of human IBD, we initially found anti-IBD effects of CMPs in both sexes. However, recent studies showed that large chitin beads (LCBs, 40 -- 70 μm) produced better anti-IBD effect than CMPs in males, whereas, in females, CMPs and LCBs were equally effective. Poor anti-IBD effects were found in both sexes treated with dietary de-acetylated chitin (chitosan) mircoparticles or soluble chitin. Our additional results suggest several key host factors regulating anti-IBD effects of chitin, including CD14-mediated macrophage activation, stomach acidic mammalian chitinase activity, and gut colonization by Candida albicans and other fungi recently strongly implicated in IBD pathogenesis. Interestingly enough, the contribution of these host factors to anti-IBD effect appears to be distinct between sexes and/or dependent on estrogen sex hormone. These results and future clinical studies will ultimately reduce excess risk for IBD and for other chronic inflammatory diseases in women, and increase women's health. (3473) Rationale for Routine Collection of Patient Reported Outcomes During Integrative Medicine Consultation Visits Stephanie W Skarolid, MA1, Sue Fairchild, PMP1, Rachael Rivard, MA1, Anne Betzner, PhD1, Jeffery A Dusek, PhD1, Meghan JaKa, PhD1 and David Victorson, PhD1 1Chicago, Illinois Abstract Purpose: Integrative medicine (IM) is whole-person care utilizing complementary health approaches to address numerous physical or emotional influences that can impact an individual’s health. Patient-reported outcomes (PRO) are subjective measures that quantify patients’ perception of their quality of life. Our primary purpose was to assess the ability and utility of routine collection of PRO measures in an IM clinic. A secondary purpose was to examine any possible changes on longitudinal administration of the PRO measure. Results: From November 2013 through October 2016, the Patient-Reported Outcomes Measurement Information System-10 (PROMIS-10) was administered during 59% of IM provider consultation visits (7172/12 207), representing 3473 unique patients. Most patients were female (81%), White (93%), middle-aged (49.2; SD 15.4), and had commercial health insurance (66%). Baseline mental (44.9; standard deviation [SD] 9.1) and physical health (44.2; SD 8.6) scores were roughly 0.5 SD below the national mean values (50; SD 10). Factors such as age, race, and noncommercial insurance were associated with lower PROMIS-10 scores. Patients completing at least 2 questionnaires (n = 1541) exhibited increases of 2.3% and 2.8% from first to last PROMIS-10 assessment in mental and physical heath scores, respectively.  Conclusions: It is possible to routinely collect PRO measures in large IM clinic and longitudinal improvements in mental and physical health scores were observed. Future research should focus on understanding how providers can utilize PRO results in real time to improve patients’ clinical outcomes and potentially decrease health-care utilization. (3474) Association Between Utilization of Chiropractic Services for Treatment of Low Back Pain and Use of Prescription Opioids James Whedon, DC, MS1, Andrew WJ Toler, MS2, Justin M Goehl, DC, MS3 and Louis A Kazal, MD3 1Southern California University of Health Sciences, Whittier, California 2Toler Training Institute, LLC, The Woodlands, Texas 3Geisel School of Medicine at Dartmouth, Hanover, New Hampshire Abstract Purpose: 15-min oral presentation. Purpose: The overuse of prescription opioids for treatment of low back pain is associated with addiction, adverse drug events, and escalating costs. Chiropractors offer nonpharmacological treatments for low back pain, and use of chiropractic services may be associated with reduced use of opioids. This study was intended to quantify the association between utilization of chiropractic services for low back pain and use of prescription opioids. Results: The adjusted likelihood of filling a prescription for an opioid analgesic in 2014 was 55% lower among recipients as compared to nonrecipients of chiropractic services (odds ration [OR] 0.45; 95% CI 0.40–0.47; P < .0001). In 2014, annual per-person charges were 78% lower for opioid prescriptions and 71% lower for clinical services among recipients as compared to nonrecipients. Conclusions: Utilization of chiropractic services is correlated with reduced use of prescription opioids. It is unknown whether this association results from use of chiropractic care or unmeasured differences between cohorts. Future research on this correlation will focus on further reducing the risk of bias and accounting for confounding factors. (3476) ADME and Anti-inflammatory Activity of the Antimalarial Drug Artemisinin Delivered Orally as Dried Leaves of Artemisia annua Matthew Desrosiers, BS1 and Pamela Weathers, PhD1 1Worcester Polytechnic Institute, Worcester, Massachusetts Abstract Purpose: Artemisia annua offers a new treatment for malaria. The plant produces the antimalarial drug artemisinin (AN) whose derivatives make up the major component of artemisinin combination therapies, the frontline global treatment for malaria. Previously, we showed that AN delivered as powdered, dried leaves of A. annua (DLA) is >40-fold more bioavailable in mice, about 4 times more soluble in intestinal fluid, and 37% more permeable to the intestinal membrane than pure AN. Furthermore, AN and several phytochemicals native to A. annua have known anti-inflammatory activity making DLA a potential anti-inflammatory therapeutic. Results: DLA-delivered AN was distributed in significantly higher quantities, up to 6-fold greater than from pure AN throughout all tested tissues. Serum tumor necrosis factor-α was significantly reduced at 1-h postgavage in DLA-treated rats. Similarly, serum interleukin-6 was significantly reduced at 2 - and 4-h postgavage in DLA-treated rats. Conclusions: In agreement with in vitro solubility and intestinal permeability data, AN delivered as DLA is more bioavailable and more readily distributed than pure AN in vivo. The effects of DLA phytochemicals on the liver need investigating to determine their role in these bioavailability differences. DLA, but not AN, given orally decreases inflammatory cytokine secretion and requires further investigation in specific inflammatory disease models. (3477) How to Build an Integrated Care Model for Chronic Conditions Danielle Greenman, MD1 and Katherine Takayasu, MD1 1Stamford Hospital, Stamford, Connecticut Abstract Overview: Navigating health care is frustrating for patients. It is equally frustrating for providers attempting to coordinate care, particularly for patients with chronic disease. At Stamford Hospital, we piloted an interdisciplinary team approach to the management of chronic pelvic pain. To date, we have treated over 150 patients with early qualitative data analysis suggesting improvements in patient-reported quality of life and provider satisfaction. Our goal is to share our approach and which can be applied to any chronic disease in a variety of health-care systems. Rationale: Chronic medical conditions are multifactorial and benefit from an interdisciplinary team approach. Outside of systems like the Veterans Administration, most providers caring for the same patient rarely communicate with each other and are not working collaboratively. Lack of collaboration often results in worsened clinical outcomes and comes at a great financial cost to the health-care system since patients with chronic conditions are the most frequent users of health care. Treatment of chronic conditions accounts for 81% of all hospital admissions, 91% of all prescriptions filled, and 76% of all provider visits, which is close to $6000 spent per patient per year. A multidisciplinary team approach addresses many of the current challenges of high-needs populations. At Stamford Health, we created a patient-centered model to help patients with chronic pelvic pain in which provider-to-provider communication was streamlined. This model is reproducible in other health-care institutions to help high-need patient populations. Objectives: The aim is to understand why a multidisciplinary team approach is needed to address chronic medical issues; gain insight into how this team approach worked at Stamford Health to address chronic pelvic pain; and extrapolate information and apply it to the learner’s home institution to address a high-need chronic patient population. (3478) Accelerometry for the Mobility Impaired: A Scoping Review in Preparation for a Randomized Study of a Mindfulness Intervention for Physical Activity Megan N Conlon, MS1 and Roni Evans, DC, MS, PhD2 1Minneapolis, Minnesota 2University of Minnesota, Minneapolis, Minnesota Abstract Purpose: Adults with mobility limitations are more likely to fall short of physical activity recommendations. In preparation for a randomized trial to test the effectiveness of a mindfulness intervention versus an educational control to increase physical activity in older adults (NCCIH 21 AT009110-01A1), we performed a scoping review. The objective was to assess whether the Actigraph GT3X+ triaxial accelerometer, the trial’s primary outcome measure, could be used in individuals with mobility impairments, which is common in older adults. While the Actigraph GT3X+ has been studied in healthy ambulatory individuals, less is known regarding its usefulness for those that are mobility impaired. Results: The search yielded 1763 articles. When duplicates were removed, there were 1445 references, of which 1361 were excluded based on title and abstract. After reviewing the 1445 abstracts, 84 studies were identified for full-text screening, and 16 studies ended up met all the criteria for inclusion. A total of 10 were validation studies, 3 addressed reliability, and 4 addressed cutpoints for determining physical activity levels. Conclusions: Using validated disability-group specific cut points and appropriate device placement protocols, we found physical activity can be accurately measured using Actigraph GT3X+ triaxial accelerometers in individuals with mobility impairments who ambulate with or without assistive devices. This is important for ensuring that older adults with mobility impairments can participate in a study of mindfulness, and potentially other complementary therapies, aimed at enhancing physical activity. (3480) Role of Ayurveda in Primary Health-care System: An Approach for Prevention and Health Promotion Jayagopal Parla, BAMS, MD, MAOM1 and Anupama Kizhakkeveettil, BAMS, MAOM, PhD1 1Southern California University of Health Sciences, Whittier, California Abstract Overview: Purpose: Ayurveda is a traditional healing system with over 5000-year history. The goal of Ayurvedic medicine is to protect the health in a healthy person and management of the disease. Ayurveda explains how lifestyle and diet recommendations, in accordance to seasons and individual body types, can be used to maintain health. A branch of Ayurveda called Rasayana (rejuvenation) deals with maintaining health and healthy aging. Herbs, supplements, dietary ingredients, and therapies described under Rasayana are studied and found to help promote tissue longevity. Their actions are attributed to their ability to remove metabolic toxins and provide an antioxidant effect. Modern literature supports this action by explaining the suppression of free radical formation, breaking free radical chain propagation and damage repair. Panchakarma incorporates detoxification therapies to remove toxins and keep the body healthy. Even though the practices of Ayurvedic health modalities have been observed for several thousands of years, there is a need for research to evaluate the effectiveness of Ayurveda. Methods: A literature search was conducted among the classical textbooks of Ayurveda and published research studies to identify the preventative and health promotive aspects of Ayurveda. Results: Detailed explanations about the health promotion and preventative aspects of Ayurveda can be seen in classical textbooks of Ayurveda. Evidence from the current scientific literature also indicates the effectiveness of these modalities for health promotion. Concepts of Ayurvedic traditional holistic health-care system can be easily integrated into one’s day-to-day life to promote a better quality of life and can play a role in the prevention of many chronic diseases. Conclusion: Drawing upon evidence from classical textbooks and the scientific literature, this presentation explains how a comprehensive natural health-care system can be used in primary care for health promotion as well as prevention of disease. Rationale: Ayurveda is a comprehensive natural holistic health-care system that can be integrated with the various practice of the system of healing. Ayurveda has unique concepts and methodologies to address health care throughout the course of life. An integrated approach that combining Ayurveda and Western medicine would benefit prevention and health promotion. This presentation explains various modalities explained in this system of medicine which can be practiced by an integrative medicine practitioner for over well-being of the patients. Objectives: The aim is to describe principles of health promotion and preventive methods in Ayurvedic system of medicine; to describe various modalities in Ayurveda for prevention and health promotion for healthy aging; and to describe the evidence from the classical textbooks and scientific literature regarding how this health care system can be used in primary care for health promotion as well as prevention of disease. (3481) Treating Major Depression With Yoga: Research Overview and Results of University of California, San Francisco Randomized Controlled Pilot Trial Sudha Prathikanti, MD1 1San Francisco, California Abstract Purpose: Conventional pharmacotherapies and psychotherapies for major depression are associated with limited adherence to care and relatively low remission rates. Yoga may offer an alternative treatment option, but rigorous studies are few. This randomized controlled trial with blinded outcome assessors examined an 8-week hatha yoga intervention as monotherapy for mild-to-moderate major depression. Results: In intent-to-treat analysis, yoga participants exhibited significantly greater 8-week decline in Beck's Depression Inventory (BDI) scores than controls (P value = .034). In subanalyses of participants completing final 8-week measures, yoga participants were more likely to achieve remission, defined per final BDI score ≤9 (P value = .018). Effect size of yoga in reducing BDI scores was large, per Cohen’s d = −0.96 (95% confidence interval, −1.81 to −0.12). Intervention groups did not differ significantly in 8-week change scores for either the, the Generalized Self-efficacy Scale or Rosenberg’s Self-esteem Scale. Conclusions: In adults with mild-to-moderate major depression, an 8-week hatha yoga intervention resulted in statistically and clinically significant reductions in depression severity. (3482) Learning From N of 1 Patient With Stage 4 Colon Cancer Has Dramatic Response to Integrative Medicine Approach Mikhail Kogan, MD1 and Bianca Palushaj1 1Washington, DC Abstract Purpose: We present a 60-year-old male with medical history of hypercholesterolemia and nephrolithiasis, diagnosed with stage IV adenocarcinoma of the colon. The patient underwent routine surgical pathology exam and was found to have a primary tumor of 6.5 cm in the cecum (histologic grade: low, moderately differentiated) with extension into the serosal surface, greater than 6 positive regional nodes, and distant metastasis to the omentum. He initially presented to our clinic 9 days status post partial right colon resection to discuss adjuvant chemotherapy versus radiation versus intravenous (IV) vitamin C versus IV mistletoe. We started him on a sugar-free, therapeutic diet. In addition, he quit tobacco use and initiated high-dose cannabis oil, methylated multivitamin, Designs for Health OmegaAvail, Hepatatone Plus, Klaire Labs Therbiotic Complete, and low-dose Naltrexone HCl (4 mg). He received standard chemotherapy to shrink the tumor and 7 weeks of once weekly IV vitamin C. Results: Subsequently, the patient underwent exploratory laparotomy, during which no cancer was detected, and biocept liquid biopsy tests were negative for circulating tumor cells (defined as CD45−, DAPI+, CK+ or CK− cell). Conclusions: This case represents an unusual response to a combination of chemotherapy and integrative approaches. Such “miracle cancer cures” are occasionally seen in integrative medicine practices and often generate lots of hype among cancer patient communities. Unfortunately, a clear understanding of how this result was achieved in this patient is not possible; however, we strongly believe that continuing to document and study each such N of 1 is important in order to formulate specific research questions and future directions. Our team will continue to follow this patient and will report in 2–3 years on his condition. (3489) Yoga for Quality of Life in Chronic Disease Patients—A Systematic Review Anupama Kizhakkeveettil, BAMS, MAOM, PhD1, Eric Hurwitz, DC, PhD2, Laura Schmalzl, PhD1 and James Whedon, DC, MS1 1Southern California University of Health Sciences, Whittier, California 2University of Hawaii, Honolulu, Hawaii Abstract Purpose: Chronic disease is the leading cause of death and disability worldwide, and people living with chronic disease also experience reduced quality of life (QOL). Yoga is a traditional health practice that includes physical movement, breath regulation, and meditative components. Yoga confers certain health benefits, but the effectiveness of yoga for improving QOL among chronic disease patients is uncertain. The objective of this study was to conduct a systematic review on the effect of yoga versus usual care for improving quality of life in patients with chronic disease. Results: A total of 1488 studies were identified from our initial search based on the above criteria. Among these, only 7 studies met inclusion criteria as determined by full text review. The yoga practices used in these studies include both posture and breathing practices. All 7 studies showed that interventions incorporating yoga were more effective than usual care alone for the improvement of QOL in patients with chronic disease. However, statistically significant between-group differences were detected for at least one QOL outcome in only 5 of the 7 trials. Conclusions: The current literature suggests that yoga may be an effective therapeutic approach for improvement of QOL in patients with chronic disease. However, the quality of studies included in this review was generally low. Further research using rigorous methods is needed to establish more conclusive evidence. (3491) Clinical Hypnosis With Graded Exposure to Feared Foods in the Treatment of Dysphagia: A Case Study Danielle M Dorn, MA and Lindsey McKernan PhD1 1Nashville, Tennessee Abstract Purpose: Treatment of dysphagia is complex, involving significant psychological burden. In addition to pain and difficulty swallowing, symptoms can include food avoidance, mealtime panic, and weight loss. Visceral hypersensitivity is theorized to drive esophageal symptoms.1 Clinical hypnosis is an established treatment for patients with anxiety disorders as well as a variety of medical conditions such as irritable bowel syndrome.2 Although the literature is very limited, hypnosis is considered an appropriate treatment for dysphagia to promote relaxation, decrease sensitivity, and modulate reactions to physical discomfort.1 We present a case of hypnosis with graded exposure in a patient suffering from severe dysphagia, food avoidance, and neck pain postcervical anterior laminectomy. Efficacy is measured by reference to posttreatment changes in pain, anxiety, depression, and other correlates with 6 - and 9-month follow-up. Results: We observed significant reductions across all measures following treatment, and these reductions were maintained over a 6 - and 9-month posttreatment period (Table 1). Immediately posttreatment, the patient reported a 64% reduction in overall pain, 74% reduction in anxiety sensitivity, 79% improvement in quality of life, and 85% reduction in trauma symptoms. As impressive, scores at 6 and 9 months remained lower than posttreatment levels across all instruments. Modest posttreatment declines over time lend further evidence of treatment effects. Conclusions: This patient maintained treatment gains and a significant increased ability to eat foods without hesitation at the end of the 9-month period. This case study provides additional support for hypnosis and graded exposure as effective treatments of dysphagia. (3496) Research on Substances and Energy Metabolism Mechanisms of Yinlai Decoction Treating Pediatric Pneumonia Based on Methods of Network Pharmacology Jingnan Xu, MD1, Ling Huang, MD1, Chen Bai, MD1, Xiaohong Gu, MD1, Tiegang Liu, PhD1, He Yu, PhD1 and Yuxiang Wan, MD1 1Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: Based on the methods of network pharmacology, the authors aim to explore the potential targets and mechanisms of substances and energy metabolism with Yinlai Decoction treating pediatric pneumonia and provide a targeted guidance for subsequent experimental study. Results: We obtained 15 molecular compounds, 68 key targets proteins, and 61 related genes of substances and energy metabolism with Yinlai Decoction treating pediatric pneumonia, involving 27 signaling pathways (false-discovery rate <0.01), which are mainly relevant to substances and energy metabolisms, such as amino acids metabolism, fatty acid metabolism, glycolysis, and drug metabolism, including Arginine and proline metabolism, glycine, serine, and threonine metabolism, tyrosine metabolism, biosynthesis of amino acids, alanine, aspartate, and glutamate metabolism, Drug metabolism-cytochrome P450, carbon metabolism, and so forth. Conclusions: Yinlai Decoction can participate in the regulation of complex substances and energy metabolism pathways, such as amino acid metabolism and fatty acid metabolism, which may be the underlying mechanism for treating pediatric pneumonia, yet the specific regulatory mechanisms still need further studies to explore and verify. (3499) An Evidence-based Review on Integrative Medicine in Weight Control Monirsadat Sahebkarkhorasani, MD1, Hoda Azizi, MD, PhD1, Mahdi Yousefi, MD, PhD1, Roshanak Salari, PharmD, PhD1, Hamidreza Bahrami-taghanaki, MD, MPH, PhD1 and Pardis Behravanrad2 1Mashhad University of Medical Sciences, Mashhad, Islamic Republic of Iran 2Science and Research Branch, Islamic Azad University, Tehran, Islamic Republic of Iran Abstract Purpose: Considering the high prevalence of obesity in the world and Iran, its serious complications, failure of standard treatments in many patients, and recent trends towards complementary medicine, awareness of the effectiveness and side effects of such therapies seems necessary. This research aimed to review the effectiveness, safety and side effects of complementary medicine in obesity. Results: In total 86 articles were found related to the subject among which 79 fulfilled the inclusion criteria, entered the study and were reviewed. Among the herbs and supplements used for weight control agar, psyllium, alpha lipoic acid, conjugated linoleic acid, diacylglycerol, aloe, caffeine, calcium, bean pod and vitamin D have acceptable scientific evidence for efficacy and safety. Among non-herbal complementary therapies, yoga and meditation have shown promising scientific evidence. Conclusions: Agar, psyllium, alpha lipoic acid, conjugated linoleic acid, diacylglycerol, aloe, caffeine, calcium, bean pod, vitamin D, yoga and meditation could be suggested as complementary and integrative treatments besides the standard treatment of obesity, with acceptable effectiveness and safety. (3501) Chinese Herbal Medicine for People Living With HIV in Guangxi, China: Analysis of Registered Data Nuala McGrath, PhD1, Nicola Robinson, PhD2, Jin Sun, PhD3, Jianping Liu, PhD3, Feng Jiang, PhD4, Mei Han, PhD5 and Ying Zhang, PhD3 1University of Southampton, London, UK 2London South Bank University, London, UK 3Beijing University of Chinese Medicine , Beijing, China 4Reikang Hospital, Nanning, China 5Beijing University of Traditional Chinese Medicine, Beijing, China Abstract Purpose: Chinese herbal medicine (CHM) has been used for treating people living with HIV/AIDS (PLWHA) in China for over 20 years. The National Free Traditional Chinese Medicine HIV/AIDS Treatment Program provided CHM for PLWHA from 2004.We analyzed registered data from Guangxi region as to inform practice and policy-making. Results: Two thousand five hundred seventy-two records of PLWHA in registered data from 2004 to 2016 were analyzed. Mean age was 47.87 ± 13.97 years, and 64.8% were male. Mean follow-up duration was 18 months. Most participants (85.4%) considered their possible HIV-infected route as sexual behavior, and followed by drug abuse (11.6%). One thousand three hundred seventy-four PLWHA (18.2% at AIDS stage) used CHM alone, and 1198 PLWHA (44.3% at AIDS stage) used CHM combined with antiretroviral therapy (ART). Participants from CHM alone group showed better baseline on CD4 cell levels (n = 1111, 380.11 ± 240.59 cell/μL) than those from CHM plus ART group (n = 1053, 271.45 ± 181.54 cell/μL). CD4 cell levels of PLWHA in both groups improved significantly after 3 months treatment. CD4 cell levels from CHM and CHM plus ART groups reached peak at 499.49 ± 199.25 (n = 87) and 442.83 ± 232.22 (n = 66) cell/μL by 48 months, respectively. CHM treatment showed no significant improvement for quality of life (QOL). However CHM plus ART showed significantly improved QOL for the first-year treatment. For PLWHA at AIDS stage, both groups demonstrated significant improvement for QOL at the first-year treatment. There was no report on serious adverse events by monitoring liver and kidney function. Conclusions: It appears that CHM used alone or combined with ART have potential improving in CD4 cell levels and may benefit PLWHA at AIDS stage on QOL. However, herb and drug interaction is not clear based on the registered data. (3502) Research on Immunoregulatory Mechanisms of Yinlai Decoction Treating Pediatric Pneumonia Based on Methods of Network Pharmacology Yuxiang Wan, MD1, Xiaohong Gu, MD1, Ling Huang, MD1, He Yu, PhD1, Chen Bai, MD1, Tiegang Liu, PhD1 and Jingnan Xu, MD1 1Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: Based on the methods of network pharmacology, the authors aim to explore the potential targets and immunoregulatory effect mechanisms of Yinlai Decoction and provide a scientific basis for the further explanation of the mechanism for treating pediatric pneumonia. Results: We obtained 90 molecular compounds and 433 key targets proteins of Yinlai Decoction treating pediatric pneumonia, involving 84 signaling pathways and relevant biological processes (false-discovery rate <0.05). In the network comprised with those functioning targets, there were 18 molecular compounds, 40 key targets proteins and 5 signaling pathways associated with immunoregulatory, namely, IL-17 signaling pathway, T cell receptor signaling pathway, Th1 and Th2 cell differentiation, Th17 cell differentiation, and Toll-like receptor signaling pathway. Conclusions: The immunoregulatory mechanism of Yinlai Decoction treating pediatric pneumonia is probably concerned with imbalance of Th1/Th2 and Th17/Treg, yet specific regulatory mechanisms still need further studies to explore and verify. (3507) The Clinical Study on Association Between Gastrointestinal Heat Retention Syndrome and Intestinal Microbiome Disorder in Children Yuxiang Wan, MD1, Xiaofei Li, MD2, Zian Zheng, PhD1, Jianhua Zhen, PhD3, Tiegang Liu, PhD1, He Yu, PhD1, Xiaohong Gu, MD1, Yunhui Wang, MD1, Xueyan Ma, MD and Fei Dong PhD4 1Beijing University of Chinese Medicine, Beijing, China 2People’s Hospital of Leling City, Dezhou, China 3China-Japan Friendship Hospital, Beijing, China 4Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: Gastrointestinal heat retention syndrome (GHRS) is a syndrome that is associated with increased gastrointestinal heat caused by a metabolic block in energy. Symptoms are intolerance to heat, dry mouth, a preference for cold drinks desire, swift digestion with increased apatite, dry and smelly stool, a reddened tongue with yellow fur, and so on. We aim to explore the relationship between GHRS and intestinal microbiome disorder in children by detecting the feces samples using high-throughput sequencing method. Results: Fifty feces samples were collected from volunteers which comprises of 12 healthy boys (H-B), 12 healthy girls (H-G), 14 GHRS boys (GHRS-B), and 12 GHRS girls (GHRS-G). The intestinal microbiome which has been annotated in children covered 20 phylum, 30 classes, 65 orders, 105 families, 156 genus, and 66 species. The genus, bacteroides, and faecalibacterium were the predominant bacteria. However, there was neither significant difference in gut microflora between GHRS and healthy children nor was there any findings in the characteristic index related to GHRS. Conclusions: The intestinal microbiome in children showed diverse structural characteristics, but there was no observable difference between the GHRS and healthy children, this might due to the small sample size in this study. Therefore, large sample size is needed to explore the association between GHRS and intestinal microbiome disorder in the future. (3508) Proteomic Analysis of Effects of Yinlai Decoction on Dyspepsia-pneumonia in Mice Yunhui Wang, MD1, Xueyan Ma, MD1, Liyi Yan, MD1, Xiaohong Gu, MD1, He Yu, PhD1, Tiegang Liu, PhD1, Chen Bai, MD1, Jingnan Xu, MD1, Zian Zheng, MD1 and Yuxiang Wan, MD1 1Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: To explore the mechanism of Yinlai decoction in the treatment of dyspepsia–pneumonia (DP) mice. Results: In DP group, the alveolar structure was destroyed, and the pulmonary septum was significantly widened. There was vascular dilatation and congestion, accompanied by a large number of inflammatory cell infiltration. After Yinlai decoction treatment, the pathological changes were alleviated. A total of 2626 proteins were reliably identified in the lung tissue. Compared with normal group, the DP mice had 521 differential proteins identified from lung tissues, which are involved in the following biological processes: biological adhesion, cell adhesion, organonitrogen compound metabolic process, peptide metabolic process, response to organic substance, response to chemical, small molecule metabolic process, oxidation–reduction process, immune system process, defense response, and response to cytokine. They are also involved in the following Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways: extracellular matrix-receptor interaction, focal adhesion, leukocyte transendothelial migration, tricarboxylic acid (TCA) cycle, and phagosome. Compared with DP group, 87 differential proteins were identified from lung tissues of Yinlai decoction treatment mice, which involved in the following biological processes: TCA cycle and lymphocyte costimulation, and so on. The related KEGG pathways included TCA cycle, oxidative phosphorylation, fatty acid metabolism, and so on. Conclusions: Differential proteins expressed in lung tissues of DP mice are mainly related to immunity, inflammation, and metabolism. Yinlai decoction may play a therapeutic role through regulating metabolism and immunity of the body. (3509) Anthroposophic Therapeutic Speech for Asthma Patients—A Randomized, Controlled Cross-over, Multi-center Trial in a Real-life Outpatient Setting Dietrich von Bonin, MME1, Eva Streit, MD2, Oliver Avianus, MS3, Christian Grah, MD3, Jörg Salomon, MD4, Sabine D Klein, PhD5, Jana Würker, MS6 and Ursula Wolf, MD5 1KSKV/CASAT, Bern, Switzerland 2Kinik Arlesheim, Arlesheim, Switzerland 3Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany 4Salem-Spital, Bern, Switzerland 5University of Bern, Bern, Switzerland 6Private Practice, Dresden, Germany Abstract Purpose: Breathing retraining techniques receive increased attention in the management of asthma, because there is growing evidence for the usefulness of such methods to improve quality of life, to reduce symptoms and bronchodilator use. Anthroposophic therapeutic speech (ATS) applies, for example, sounds, syllabic rhythms, and quality of sound, is one of the classic anthroposophical medicine artistic therapies. In this study, we investigated the effect of ATS in patients with asthma in a real-life outpatient setting. Results: Sixty-three patients were randomized, 56 were enrolled, and 49 completed the study. Statistically significant differences between ATS and waiting control were found for the Asthma Quality of Life Questionnaire overall score (d = 0.86, P = .001) and its domains symptoms, activity limitation, and emotional function as well as the American College Testing score (d = 0.53, P = .048). No significant differences were observed in spirometry parameters, inhaled glucocorticoids, peak flow, and days without asthma exacerbation per week. No serious adverse events occurred during ATS sessions. Conclusions: ATS significantly improves asthma control and quality of life in patients with asthma. It remains to be shown whether ATS may also improve lung function. (3514) Tinospora Cordifolia Controls Arthritis by Modulating the Mediators of Autoimmune Inflammation and Bone Remodeling Kamal D Moudgil, MD, PhD1, Shivaprasad H Venkatesha, PhD1 and Kumar Sannegowda, PhD1 1University of Maryland School of Medicine, Baltimore, Maryland Abstract Purpose: Herbal products offer a versatile resource for identifying and characterizing new therapeutic agents that have the potential for the control of various inflammatory and autoimmune diseases, including rheumatoid arthritis (RA). The need for such agents in RA is evident from the reports that about 40% of patients fail to respond to biologics (anticytokine therapeutics) and other mainstream drugs. Furthermore, the long-term use of such drugs frequently results in severe adverse reactions. Therefore, RA patients are gradually resorting to the use of herbal products for their unmet medical needs. However, limited information about the mechanisms of action of many natural products is a major hurdle in the widespread acceptance of herbal therapy by professionals and patients alike. Results: Tinospora treatment suppressed arthritic inflammation and bone and cartilage damage. These effects of Tinospora were mediated via reduction of the pro-inflammatory cytokines (interleukin-1 [IL-1], IL-6, tumor necrosis factor -a, and IL-17), the frequency of T helper 17 (Th17) cells that produce IL-17, and the production of chemokines such as regulated and activated normal T-cell expressed and secreted. Furthermore, Tinospora treatment afforded protection against bone damage by skewing the balance of mediators of bone remodeling (eg, receptor activator of nuclear factor kappa-Β ligand and matrix metalloproteinase -9) in favor of anti-osteoclastic activity. Conclusions: Tinospora effectively controlled arthritis via modulation of various mediators of inflammation and tissue damage in arthritic rats. On the basis of our results, we propose that Tinospora should be evaluated for its utility as a therapeutic adjunct to the mainstream drugs for RA therapy. (3515) Comparison of Randomized Controlled Trials and Guideline Recommendations of Oral Chinese Patent Medicine for Acute Lower Respiratory Tract Infections in Adults Yu-tong Fei, MD, PhD1, Michael Moore, MD, PhD2, Xiao-yang Hu, MD, PhD2, Di Wang1, Ying Wang1, Andrew Flower, MD, PhD2, Xun Li, PhD1, Merlin Willcox, DPhil, MRCGP2, Lily Lai, MD, PhD2, Jian-ping Liu, MD, PhD1, Rui-xue Hu1 and Ru-yu Xia, PhD1 1Beijing University of Chinese Medicine, Beijing, China 2University of Southampton, Southampton, UK Abstract Purpose: Chinese patent medicines (CPMs) are widely used for acute lower respiratory tract infections (ALRTIs) in China (60% market share). We aimed to compare recommendations on the use of oral CPM for ALRTIs from clinical practice guidelines (CPGs) with existing evidence of randomized controlled trials (RCTs) to inform practice. Results: We identified 29 RCTs (5093 patients) on 42 CPMs for ALRTIs. Thirty-seven CPMs has only 1 trial each. Five CPMs have 2 trials each but no similar comparisons. Each meta-analysis was only with small sample size and very low certainty. For the 6 guidelines identified, 29 CPMs were recommended. Four of them were identified both in the RCTs and in CPGs. Ninety-three percent (27/29) of the recommendations of CPMs in CPGs were not based on RCT evidence. Ninety-five percent (40/42) of the CPMs identified from this systematic review of RCTs were not mentioned in the CPGs. Both RCTs and CPGs were generally low quality. Conclusions: Evidence base of CPMs for ALRTIs was very weak. CPGs were not evidence-based. Massive use of CPM for ALRTIs was neither based on scientific evidence nor guidelines. There is an urgent call for good quality research to inform massive clinical use. (3516) Comparison of Randomized Clinical Trials on Sham/Placebo Acupuncture by Western and Eastern Country Origins JianPing Liu, PhD1, Liqiong Wang, PhD1, Chunxiang Su, PRO1, Yu-tong Fei, MD, PhD1, Guoyan Yang, PhD2 and Ning Liang, MD1 1Beijing University of Chinese Medicine, Beijing, China 2Western Sydney University, Sydney, Australia Abstract Purpose: To describe and compare the randomized clinical trials (RCTs) on sham/placebo acupuncture by their country origins (Western and Eastern). Results: A total of 532 sham/placebo acupuncture RCTs (384 from Western countries and 148 from Eastern countries) were identified. The top 3 Western countries which published most acupuncture RCTs were United States (17.3%), Germany (13.1%), and UK (9.8%), while Eastern countries were mainland China (12.6%), South Korea (4.7%), and Taiwan Region (3.9%). There was a statistic difference in acupuncture RCTs by published journals (P < .001). RCTs from the West were published more frequently in professional medical journals (47.9%), while RCTs from Eastern countries were more published in complementary and alternative medicine journals (55.4%). The most commonly treated conditions by acupuncture RCTs were musculoskeletal and connective tissue diseases (22.1% vs 14.2% by Western and Eastern countries). Manual acupuncture was used more in the West than the East (65.6% vs 50.7%, P < .001). There was no statistical difference for the reported outcomes including clinical, surrogate, and safety between Western and Eastern countries. RCTs from Eastern countries reported more positive results compared with Western countries (79.7% vs 56.0%, P < .001). However, there was no significant difference between country origins in low risk of bias including generation of allocation sequence (49.7% vs 54.7%), concealment (44.3% vs 39.9%), incomplete outcome (69.3% vs 79.7%), and selective reporting (79.2% vs 84.5%). Conclusions: Sham/placebo acupuncture RCTs show significantly difference on journal type, acupuncture type, and reporting positive results between Western and Eastern countries. Future acupuncture RCTs should have a very clear clinical research question, hypothesis, and rigorous design with registered protocol and transparent reporting. (3522) Light Therapy for Treating Sleep and Mood Disruption in Brain-injured Patients George Brainard, PhD1, Stevi Anderson, MS2, Melanie McKendry, RMA1, Samar Colette Glatts, MS2, Sreeramya Jasser, MD1, Leanna Kanumilli, MD1, Benjamin Panepinto, BS1, Maria Warfield, BFA1, John Pineda, MD1, Talia Hanifin, PhD1, Kimberly Glodjo, BS1, Mijail Atkinson, DO1, Lisa Serruya, PhD, MD1, Fadee Bowman, CRNP1 and Disoke, BA1 1Thomas Jefferson University, Philadelphia, Pennsylvania 2Rothman Institute, Philadelphia, Pennsylvania Abstract Purpose: Light is a potent stimulus for regulating circadian, neuroendocrine, and neurobehavioral responses in healthy humans. Further, light therapy is effective for treating selected affective, circadian, and sleep disorders. The purpose of this research is to characterize sleep and mood disruption in brain-injured patients and determine whether light therapy can improve such symptoms. Results: Actigraphy provides an objective measure of circadian and sleep stability in all 3 studies. For example, in the completed studies, actigraphy demonstrated that mild traumatic brain injury (mTBI) patients had statistically and clinically meaningful longer sleep latencies compared to control subjects (P < .02). Similar significant results were observed in the study with stroke patients (P < .005). Validated measures of mood disturbance showed that mTBI patients had significantly increased mood disturbance (P < .001) compared to control subjects. Stroke patients also showed significantly increased mood disturbances (P < .0001) compared to their matched control subjects. Conclusions: The results are potentially important to the integrative medical care of patients with brain injury. It is valuable to provide patients with a nonpharmacological, built-in stimulus that can ameliorate their symptoms. These studies will contribute to the design of future built-in smart lighting interventions for hospitals and home care environments to foster patient health and well-being. Support: The Institute for Integrative Health; NSF #EEC-0812056; and the Philadelphia Section of Illuminating Engineering Society NA. (3524) Exploring the Impacts of Yinlai Decoction on Mechanical Barrier Function of Intestinal Mucosa of Mice With High-fat and Calorie-diet Combined With FM1 Influenza Virus Infection Yu Hao, PhD1, Yunhui Wang, MD1, Teck C Kong, MD2, Zeji Qiu, MD1, Jun Wu, MD1, Jianhua Zhen, PhD3, Xiaofei Li, MD4, Jingnan Xu, MD1, Tiegang Liu, PhD1, He Yu, PhD1 and Xiaohong Gu, MD1 1Beijing University of Chinese Medicine, Beijing, China 2Nanyang Technological University, Singapore, Singapore 3China-Japan Friendship Hospital, Beijing, China 4People’s Hospital of Leling City, Dezhou, China Abstract Purpose: To explore the influence Yinlai decoction has on the mechanical barrier function of the intestinal mucosa of mice with high-fat and calorie-diet induced with FM1 influenza virus infection and to identify the efficacy of Yinlai decoction and its potential mechanism. Results: Compared with the normal group, the levels of zonula occludens-1 (ZO-1) mRNA in colon tissue decreased significantly (P < .05) and the levels of lipopolysaccharide (LPS) in serum increased significantly (P < .05) in infection group as well as the high-fat and calorie-diet infected compound group. Compared with the high-fat and calorie-diet infected compound group, the levels of ZO-1 in colon tissue and LPS in serum decreased significantly (P < .05) in positive treatment groups, it increased significantly (P < .05) in the Xiaoerhuashiwan group. Compared with the normal group, the levels of ZO-1 mRNA decreased significantly (P < .05) in each treatment group, the levels of ZO-1 in colon tissue decreased significantly (P < .05) in positive treatment group, the levels of LPS in serum increased significantly (P < .05) in each dose of Yinlai decoction group, Shuanghuanglian group, and Xiaoerhuashiwan group. Conclusions: Yinlai decoction can influence the levels of ZO-1 in colon tissue and reduce the content of LPS in serum, which may be a mechanism to protect the intestinal mucosa that functions as a mechanical barrier. (3526) Integrative Pediatric Inpatient Wards in Germany: Analysis of Clinical and Demographic Characteristics Jan Vagedes, MD1, Markus Krüger, MD2, David Martin, MD3, Tycho Zuzak, MD4, Katharina Fetz, MSc3, Thomas Ostermann, PhD3, Alfred Längler, MD5 and Melanie Schwermer, PhD6 1Academic Research in Complementary and Integrative Medicine, Filderstadt, Germany 2Filderklinik, Filderstadt, Germany 3University Witten/Herdecke, Witten, Germany 4Gemeinschaftskrankenhaus Herdecke, University Hospital Essen, Herdecke, Essen, Germany 5Gemeinschaftskrankenhaus Herdecke, University Witten/Herdecke, Herdecke, Witten, Germany 6Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany Abstract Purpose: Integrative medicine is frequently used in adults as well as in children in Europe. In Germany, there are 2 anthroposophical pediatric wards: The Gemeinschaftskrankenhaus in Herdecke and the Filderklinik in Filderstadt near Stuttgart. Until today, there are no systematic analyses of patient characteristics in integrative pediatric hospitals in Germany. Results: Patients in the integrative pediatric sample were 47.6% female (n = 15 697) and 52.4% male (n = 14 259). The gender distribution did not differ significantly from representative data (female: n = 4 046 229 [46.80%]; male: n = 4 598 256 [53.19%]). Median age was 3 years (range −1 to 45). In the representative sample, median age was 3.5 years (range 0–101). Most frequent diseases in the integrative pediatric sample were diseases of the respiratory system (n = 5019; 17.1%), infectious and parasitic diseases (n = 3859; 12.9%), and diseases of origin in perinatal period (n = 3547; 11.8%). In the representative sample, most frequent diseases were diseases of the respiratory system (n = 1 714 182; 19.83%) and infectious and parasitic diseases (n = 1 281 000; 14.82%) and sequelae of injuries, of poisoning and of other consequences of external causes (n = 999 233; 11.56%). Frequencies of the focus diagnoses in the integrative pediatric sample were pneumonia (n = 1702; 5.68%), bronchitis (n = 1782; 5.95%), bronchial asthma (n = 451, 1.5%), and gastroenteritis (n = 2364; 7.89%). Conclusions: The characteristics of patients in integrative pediatric hospitals in Germany are comparable to those of standard pediatric German wards. (3528) Integrative Hospitals in Germany: Analysis of Pediatric Patients With a Focus on Health Economic Parameters Melanie Schwermer, PhD1, Alfred Längler, MD2, Tycho Zuzak, MD3, Katharina Fetz, MSc4, Thomas Ostermann, PhD4, David Martin, MD4, Markus Krüger, MD5 and Jan Vagedes, MD6 1Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany 2Gemeinschaftskrankenhaus Herdecke, University Witten/Herdecke, Herdecke, Witten, Germany 3Gemeinschaftskrankenhaus Herdecke, University Hospital Essen, Herdecke, Essen, Germany 4University Witten/Herdecke, Witten, Germany 5Filderklinik, Filderstadt, Germany 6Academic Research in Complementary and Integrative Medicine, Filderstadt, Germany Abstract Purpose: Integrative medicine is frequently used in adults as well as in children in Europe. In Germany, there are 2 anthroposophical pediatric wards: The Gemeinschaftskrankenhaus in Herdecke and the Filderklinik in Filderstadt near Stuttgart. Until today, there are no systematic analyses of health economic parameters of integrative pediatric hospitals in Germany. Results: Most frequent diagnosis-related groups (DRGs) in integrative pediatric hospitals were B80Z (head injuries; n = 1933, 6.5%), G67B (oesophagitis, gastroenteritis, gastrointestinal bleeding, ulcer, complex genesis; n = 1286, 4.3%), P67C (newborn >2499 g, without complex diagnosis; n = 1254, 4.2%), G67C (oesophagitis, gastroenteritis, gastrointestinal bleeding, ulcer, uncomplex genesis; n = 1158, 3.9%), and P67B (n = 975, 3.3%, newborn >2499 g, with complex diagnosis). Mean duration of stay was significantly lower in the integrative pediatric sample (M = 4.74 days (standard deviation [SD] = 6.23) than the mean duration of stay proposed by DRG (M = 5.80), t(28,235) = −37.74; P < .001. In the representative sample, the mean duration of stay was 4.48 days (SD = 7.83). The mean effective cost weight in the integrative pediatric sample was 0.76 (SD = 1.22). Conclusions: Here, we present first systematic analyses of health economic parameters of integrative pediatric hospitals in Germany. The duration of stay in integrative pediatric hospitals was shortened compared to DRG-expected mean duration of stay. Duration of stay seems to be comparable in integrative and conventional pediatric hospitals. An important implication for future research is to compare these data further with representative data of conventional pediatric wards in Germany. (3529) Improvements in Psychological Well-being Following a Residential Yoga-based Program for Professionals: A Pragmatic Clinical Trial Edi Pasalis, MBA1, Jeffrey A Dusek, PhD2, Natalie L Trent, PhD3, Mindy Miraglia, MS1 and Sat Bir S Khalsa, PhD3 1Kripalu Center for Yoga & Health, Stockbridge, Massachusetts 2Aurora Health Care, Milwaukee, Wisconsin 3Brigham and Women’s Hospital, Boston, Massachusetts Abstract Purpose: The purpose of this pragmatic, real-world controlled trial was to examine changes in psychological well-being and health-related behaviors in professionals that attended a residential yoga-based program. Results: Relative to the control group, participants in the experimental group reported significant improvements in perceived stress (P = .002), positive affect (P = .01), negative affect (P = .004), and vegetable consumption (P = .03) from baseline to postprogram. From baseline to follow-up, participants in the experimental group exhibited statistically significant improvements in mindfulness (P = .03), perceived stress (P = .004), positive affect (P = .03), negative affect (P = .03), self-compassion (P = .04), and vegetable consumption (P = .01) compared to controls. Conclusions: To date, these findings suggest that the resilience, integration, self-awareness, engagement program improves psychological well-being and health-related behaviors immediately following the program which were sustained at the 2-month follow-up. (3530) The Effects of a Yoga-based Stress Reduction Program on Fatigue and Quality of Life in Women With Adjuvant Chemotherapy for Breast Cancer: A Multicenter, Pragmatic, Randomized Clinical Study Herman A van Wietmarschen, PhD1, Ellen van der Pol, MSc1, Miek Jong, PhD1 and Inge Boers, MSc1 1Louis Bolk Institute, Bunnik, the Netherlands Abstract Purpose: Breast cancer survivors report high levels of distress and persistent fatigue, negatively impacting quality of life. They are often unable or unwilling to participate in standard exercise interventions because of the experienced fatigue. There is some evidence for beneficial effects of yoga on cancer-related fatigue. A pragmatic, randomized controlled study was conducted in the Netherlands, to compare the effects of a yoga-based stress reduction (YBSR) program with usual care in stage I–III breast cancer patients after primary surgery and scheduled for chemotherapy. Results: Eighty-three breast cancer patients participated in the study: YBSR group (N = 43) and control group (N = 40). Demographic characteristics were similar at baseline. Preliminary within-group intention-to-treat (ITT) analysis showed a significant increase in general fatigue after 3 months in the control group (P = .002), but not in the YBSR group (P = .175). After 6 months, general fatigue remained significantly higher in the control group (P = . 020) but not in the YBSR group. However, no significant differences were found in general fatigue in the between-group ITT analysis after both 3 (P = .859) and 6 months (P = .065). After 3 months, there was significantly more confidence in fatigue reduction (P = .021), amount of expected fatigue reduction (P = . 001), and satisfaction with fatigue reduction (P = . 001) in the YBSR group. Significant differences in favor of the YSBR group were also found on secondary outcomes nausea and vomiting (P = .013, η2 = 0.08) and impact of event (P = . 049, η2 = 0.05) after 6 months. These effects were not due to treatment expectations since expectations of usual care were higher than that of the YBSR program (P = .002). Conclusions: Although there was no overall significant treatment effect of the yoga program on general fatigue in breast cancer patients undergoing chemotherapy, these patients do seem to benefit from such a program. Final results will be presented at the conference. (3531) Strengthening Observation Skills in Integrative Medical Practice Adam Blanning, MD1, Peter Hinderberger, MD2 and Renee Meyer, MD3 1Physicians’ Association of Anthroposophic Medicine, Denver, Colorado 2Ruscombe Mansion Community Health Center, Baltimore, Maryland 3Primula Internal Medicine, Yonges Island, South Carolina Abstract Overview: Integrative medical teaching involves not only sharing new content but also new perspectives. Practitioners seek new ways to think about health and illness. Enlivening our thinking is a central tenet in anthroposophic medical trainings and is incorporated into all elements of teaching. For example, a 4-fold methodology is incorporated into teaching herbal medicine. Over a series of days, students learn diverse but complementary observation exercises, which simultaneously facilitate learning about a specific medicinal plant in small group study. Instead of initially learning about traditional medicinal plant uses, participants are guided through a series of steps: First day: What do you see, factually? (avoiding botanical terms, without trying to be clever or interpretive); second: How do you imagine the plant changes and grows in time? (what might it look like a month from now? A month ago?); Third: What is the plant’s character? Does it show a one-sidedness?; and Finally: What is the plant's archetypal process? These steps mirror anthroposophic considerations of the physical, functional, emotional, and spiritual aspects of human physiology. Then, the group’s impressions are compared with known, traditional, and modern botanical uses. While this methodology is used for plant study, it applies equally well for phenomenological consideration of other therapeutic substances and processes. Our experience shows that this process encourages diverse, collaborative thinking. Participants gain confidence and renewed interest in their own observation and problem-solving skills. Typical comments included “plenty of time in exploring, taking in, and coming up with our thought process of the plant “being,” “different throught processes were heard and then channeled in a proper way,” “really looked at the plant in an interactive way.” The poster will demonstrate how these methods can be applied to Primula and Hyocyamus, 2 healing plants used commonly in anthroposophic medicine. Rationale: Enlivened thinking and guided group problem-solving can enrich present health ideas and therapies and encourages innovation. The present theme of chronic pain calls for creative approaches and a social dimension to healing. Objectives: This abstract is intended as a poster presentation. Interested participants will experience the lively, mobile quality of this learning methodology, as the example of the 2 medicinal plants will be presented in this way; receive lasting impressions of the dynamics of the 2 sample plants; and employ the observational, group—process character of this methodology to teaching about other findings in the natural world. (3534) Blood-letting and Herbal-cupping Therapy for Lumbar Spinal Stenosis: Prospective Case Series Study Changxin Liu1, Xingzhi Wang2, Xiyou Wang1 and Changhe Yu, PhD1 1Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China 2Guobaotang Clinic, Beijing, China Abstract Purpose: Lumbar spinal stenosis (LSS) is a degenerative condition in which changes in the discs, ligamentum flavum, and facet joints with aging cause narrowing of the spaces around the neurovascular structures of the spine. These changes lead to pain in the legs and back, as well as impaired ambulation and other disabilities. LSS affects more than 200 000 people in the United States, and it is the most common reason for spinal surgery in patients over 65 years, and the cost of surgeries on LSS was nearly $1.65 billion in 2007. But only 60%–70% of patients are satisfied with their symptoms after surgery, and there was insufficient evidence and controversy to recommend any specific types of nonsurgical treatment for LSS. A new nonsurgical technique, namely, blood-letting and herbal-cupping therapy, has been explored for LSS. It has been used for the spinal pain and pain-related function disorders including LSS in folks and the palace since Qing dynasty (more than 350 years ago). And it has been regarded as the China intangible cultural heritage, and many LSS patients has benefited from it. However, the effect of such therapy has never been proved. Thus, the purpose of study was to evaluate the safety and effectiveness of the blood-letting and herbal-cupping therapy for lumbar spinal stenosis. Results: Fifty-three patients were included, with 64.15% (34/53) of LSS showing neurogenic claudication (walking distance less than 200 m). The average age was 64.22 ± 11.68 years, 21 (39.6%) female, and the average body mass index was 25.79 ± 3.31 kg/m2. The scores of symptom severity scale of SSM were 2.79 ± 0.76, 2.63 ± 0.68, 2.27 ± 0.62, and 1.88 ± 0.21 at baseline, first, second, and third course, respectively, and the scores of physical function scale were 2.54 ± 0.79, 2.42 ± 0.68, 2.11 ± 0.51, 1.79 ± 0.29, and all the changes between baseline and each course showed significant improvement. The patient satisfaction of SSM, ODI, and SF-12 showed significant improvements after the first, second, and third course (P < .05). The SF-12 subgroup physical composite scores after third course and mental composite score after first showed no significant improvement. The minimal clinically important difference for the “Symptom Severity Scale” in the SSM was achieved with improvement of 19%, 41%, and 83% in the LSS patient population after first, second, and third course; and the “physical function scale” in SSM was achieved with improvement of 23%, 31%, and 50%. A total of 15 patients felt pain when they were micropunctured with little blood at first time, but the symptom were immediately relieved without any treatment. Conclusions: The blood-letting and herbal-cupping therapy could benefit patients with lumbar spinal stenosis after third course of treatment in the fields of symptom relief and quality of life with no severe adverse event. However, this was a phrase analysis, so more evidence of this study and large comparative researches should be warranted in the future. (3536) Cerebral Response of Healthy Subjects to a Somatosensory Stimulaton With Xingnao Kaiqiao Acupuncture Compared to Control Interventions Measured With Resting-state Functional Magnetic Resonance Imaging Claudia M Witt1, Bin Liu, MD2, Xuemin Shi2, Yinghui Chang, MD2, Daniel Pach, MD3 and Till Nierhaus, Dr rer. medic., Dipl-Ing(FH)4 1University Hospital Zurich, University of Zurich, Zurich, Switzerland 2Tianjin University of Traditional Chinese Medicine, Tianjin, China 3Charité—Universitätsmedizin Berlin, Berlin, Germany 4Freie Universität Berlin, Berlin, Germany Abstract Purpose: Neuroimaging studies have shown that stimulation at single acupuncture points can specifically modulate brain activity in comparison to stimulation of nonacupuncture points. However, the effects of acupuncture using more than 1 point are less clear. Xingnao Kaiqiao (XNKQ) acupuncture is an acupuncture technique used for the rehabiliation of stroke patients. We evaluated functional connectivity changes with functional magnetic resonance imaging (fMRI) in healthy subjects after applying XNKQ acupuncture. Results: For stimulation, we found decreased eigenvector centrality in precuneus (stimulation < nonstimulation), whereas for the factor location, no statistically significant differences in centrality were found. However, when comparing XNKQ acupuncture with manual needle-stimulation on nonacupuncture points, we found decreased centrality in midbrain structures (thalamus, caudate, and lentiform nucleus), claustrum, and cingulate cortex. The comparison of XNKQ acupuncture with the other 2 (nonstimulation) interventions showed no significant differences. Conclusions: When evaluating acupuncture on multiple points, stimulation and location of acupuncture seem to affect brain activity changes. (3538) Lessons Learned During the Integrative Medical Group Visits Randomized Controlled Trial for Recruiting Low-income Racial/Ethnic Minority Research Study Participants Anna S. Lestoquoy, MPH1 and Paula Gardiner, MD, MPH1 1Boston, Massachusetts Abstract Purpose: Integrative Medical Group Visits (IMGV) are an innovative program for delivering chronic pain and depression care. This randomized control trial compares the IMGV model to primary care appointments across 3 inner city clinics in Boston. Our participants largely identify as racial/ ethnic minorities, a historically challenging population for research recruitment. This poster will share our methods and strategies in overcoming barriers related to recruitment of this patient population. Results: A total of 331 patients were consented and screened for inclusion in the study, and 154 enrolled. Seventeen percent of those screened were male; 59% identified as Black; with the site specific demographics similar to each site’s patient population. Over the course of the study, in order to ensure a representative sample, we changed our recruitment methods to enroll a greater number of male participants. Different patients responded to different recruitment methods, with older patients responding largely to targeted letters and younger patients responding to self-referral and provider referral (P = .0003, α = 0.05). The most common reasons for declining participation was not being interested in groups or having scheduling conflicts with the group schedule. Conclusions: Different populations of patients respond to different forms of recruitment. Our varied approaches resulted in successfully recruiting our target number of participants. (3539) Exploring the Impacts of Yinlai Decoction on DLA and DAO in Serum in Mice With High-fat and Calorie-diet Combined With Pneumonia Jun Wu, MD1, Teck Chuan Kong, MD2, Zeji Qiu, MD1, Yu Hao, PhD1, Yunhui Wang, MD1, Yuxiang Wan, MD1, Zian Zheng, PhD1, Xiaohong Gu, MD1, He Yu, PhD1, Jingnan Xu, MD1, Tiegang Liu, PhD1 and Yingqiu Mao, MD1 1Beijing University of Chinese Medicine, Beijing, China 2Nanyang Technological University, Singapore, Singapore Abstract Purpose: To explore the protective effect of Yinlai decoction on DLA and DAO in serum in mice with high-fat and calorie-diet combined with pneumonia and to ascertain the potential mechanism of Yinlai decoction. Results: The DLA level in serum of pneumonia group, high-fat and calorie-diet group, and high-fat and calorie-diet combined with pneumonia group were increased significantly (P < .05) compared with the normal group. The DLA level in serum of Yinlai decoction group was decreased significantly (P < .05) compared with high-fat and calorie-diet combined with pneumonia group. The DLA level in serum of dexamethasone group was increased significantly (P < .01) compared with the normal group and Yinlai decoction group. The DAO level in serum of pneumonia group, high-fat and calorie-diet group, and high-fat and calorie-diet combined with pneumonia group were increased compared with normal group. The DAO level in serum of Yinlai decoction group and dexamethasone group were decreased compared with high-fat and calorie-diet combined with pneumonia group, but there was no statistical significance in the DAO level of serum between each group (P > .05). Conclusions: Pneumonia could lead to higher levels of DLA and DAO in serum. Yinlai decoction can reduce the pathological permeability of intestinal mucosa and the levels of DLA and DAO in serum to protect the intestinal mucosal. Dexamethasone could significantly relieve pulmonary inflammation, but concurrently causes intestinal mucosal tissue damages, which results in an increase in intestinal mucosal permeability and the level of DLA in serum as well. (3540) Improved Health Outcomes in Integrative Medicine Visits May Reflect Shifts in Physician and Patient Behaviors Compared to Standard Medical Visits Judith A Hall, PhD1, Ted J Kaptchuk2, Michelle L Dossett, MD, PhD, MPH3 and Gloria Yeh, MD, MPH2 1Northeastern University, Boston, Massachusetts 2Boston, Massachusetts 3Massachusetts General Hospital, Boston, Massachusetts Abstract Purpose: We previously demonstrated in patients with gastroesophageal reflux disease (GERD) that individuals receiving an integrative medicine visit had greater improvements in symptom severity than individuals receiving a standard empathic primary care visit regardless of treatment provided. To better understand these results, we analyzed study visit videos to assess differences in physician and patient behaviors in these 2 visit types. Results: Both visit types began similarly and most positive patient-centered impressions and nonverbal behaviors increased over the course of both visit types. In the integrative visits, the physician was rated as significantly more engaged (P = .009), friendly (P = .005), and relaxed (P = .002), smiled more (P = .006), gazed longer (P = .021), gestured more (P = .007), and spent more time talking (P = .024) compared to standard visits. There were significant time by visit type effects such that as visits progressed, patients in the integrative group were more friendly (P = .002), confident (P = .042), and pleased (P = .044) than patients in the standard visit group. Improvement in GERD symptoms was most highly correlated with patients being pleased (r = .71, P < .01) and friendly (r = .67, P < .01) at the end of the visit. Conclusions: The structure of integrative medicine visits may enhance relationship building not only improving patient-centered behaviors by physicians but also modifying patients’ responses, potentially facilitating symptom improvement. (3546) Feasibility, Acceptability, and Effectiveness of a Mindfulness-based Smoking Cessation Program for Cancer Patients Man Luo, MPH1, Paula Gardiner, MD, MPH1, Salvatore D'Amico, BS1, Marjory Charlot, MD, MPH, MSc1, Karen E Lasser, MD, MPH1 and Hasmeena Kathuria, MD1 1Boston, Massachusetts Abstract Purpose: Cigarette smoking is a major cause of cancer death and contributes to health disparities. Stress is an important trigger for cigarette smoking. Low socioeconomic and minority populations who smoke have high cancer mortality rates and are less likely to use evidence-based smoking cessation treatments. The use of mindfulness training to assist with cessation of smoking has been postulated to manage craving/withdrawal symptoms and emotional distress. This pilot project aims to test the feasibility and acceptability of mindfulness training program to engage low-income and minority current smokers with cancer to smoking cessation therapy. Results: Eighteen participants were enrolled from October 2016 to May 2017. Participant demographics were as follows: 56% identified as Black, 56% reported a yearly income of $20,000 or less, and the average age was 64 years. At baseline, 8 (44%) participants were actively undergoing cancer treatment. The average cigarette intake was 75.1 per week, and the median perceived stress score was 6.0. At follow-up, participants significantly decreased their weekly cigarette intake to 44.3 cigarettes (P = .07), and the median PSS reduced to 3.0. The number of participants who did home practice (including meditation, body scan, yoga, and mindful eating) increased from 30.8% after week 1 to 100% at week 8. Twelve (66.7%) participants attended at least half of the MBSC sessions. Conclusions: Mindfulness training is feasible and acceptable among low-income and racially diverse cancer patients who smoke. (3549) Patient Safety and Quality of Care in Chiropractic Academic Clinics: A Qualitative Evaluation of Respondent Feedback to an International Survey Maeve O'Beirne, MD, PhD1, Sunita Vohra, MD MSc1, Katherine A Pohlman, DC, MS2, Michelle M Holmes, MS3, Stacie A Salsbury, RN, PhD4 and Martha Funabashi, PhD5 1Edmonton, Alberta 2Parker University, Dallas, Texas 3Anglo-European University College, Bournemouth, UK 4Palmer College of Chiropractic, Davenport, Iowa 5Edmonton, Alberta, Canada Abstract Purpose: Patient safety and quality of care are growing concerns for all health-care settings, including clinics within educational institutions. The purpose of this study was to evaluate written feedback offered by chiropractic academic settings’ clinic personnel on the topics of patient safety and quality. Results: Of 800 academic respondents, 80 individuals provided written feedback. While quantitative survey results noted good-to-excellent scores on most items, qualitative comments identified 5 domains of concern potentially impacting patient safety and quality of care in the chiropractic academic setting. Patient safety culture described themes of patient-centeredness, safety knowledge, adverse events, medical errors, incident reports, and safety protocols. Clinic environment highlighted equipment, clinic setting, documentation systems, and personnel. Clinic processes revealed issues of appointment scheduling, visit duration, marketing/recruitment, paperwork, workload, and outcome assessments. The education domain discussed teaching style, faculty staffing, training, and comanagement. Finally, the leadership domain emphasized professional identity, quality standards, intern opportunities, and community involvement. While many issues were identified, respondents offered few solutions to improving patient safety and quality of care in this setting. Conclusions: Chiropractic personnel in academic settings are aware of patient safety and quality of care issues in their workplaces but offered few solutions. Targeted interventions to foster patient safety culture and implement sustainable quality improvement initiatives may be warranted. (3552) Crowdsourcing for Patient Engagement in Research: Results of a Qualitative Analysis Methods Study Tarek Azzam, PhD1, Gery Ryan, PhD2, Ian D Coulter, PhD2 and Lara G. Hilton, MPH2 1Claremont Graduate University, Claremont, California 2RAND Corporation, Santa Monica, California Abstract Purpose: Patient-centered care increases credibility and legitimacy of programs, participant uptake, and most importantly improves outcomes; however, the high costs and amount of time required to recruit and engage patients makes it difficult to routinely involve them in health-care research and evaluation. The purpose of this methods study is to test the feasibility of patient engagement in health research using an innovative web-based tool called crowdsourcing. Crowdsourcing is the process of obtaining services, ideas, or content by soliciting contributions from a large group of people, and especially from an online community. Results: Analyzing textual responses using a crowdsourcing platform was feasible, fast, and inexpensive. Data quality were good as compared to a clinical sample from a practice-based network. The domains of “intensity” and “function” were straightforward for Mechanical Turk (MTurk) participants to apply to text, but they found “duration” and “frequency” to be overlapping constructs. They ranked domains in this order of importance: intensity, frequency, function, and duration. Additional themes that emerged consistently across MTurk participants were no cure, pain management/treatments, cause/diagnosis, and psychological effects. Conclusions: Findings illustrate that patients value different dimensions of chronic pain than we typically use for defining it in the research context where duration of greater than 3 months of pain is the norm. In order to advance patient-centered research, we require innovative, efficient tools such as crowdsourcing to increase patient inclusion and participation; this new experimental system has the potential to enhance patient engagement in clinical research, evaluation, and policy. (3553) Exploring the Impacts of Yinlai Decoction on Colonic Ultrastructure in Mice With High-fat and Calorie-diet Combined With Pneumonia Zeji Qiu, MD1, Jun Wu, MD1, Teck C Kong, MD2, Yu Yunhui Wang, MD1, Tiegang Hao, PhD1, Jingnan Liu, PhD1, He Xu, MD1, Xiaohong Yu, PhD1, Zian Gu, MD1, Yuxiang Zheng, PhD1, Yingqiu Wan, MD1 and Mao, MD1 1Beijing University of Chinese Medicine, Beijing, China 2Nanyang Technological University, Singapore, Singapore Abstract Purpose: To explore the protective effect of Yinlai decoction on colonic ultrastructure and intestinal mucosa in mice with high-fat and calorie-diet combined with pneumonia and to ascertain the potential mechanism of Yinlai decoction. Results: The mice colon mucosa of pneumonia group reflected an inconsistent size of microvilli. In the high-fat and calorie-diet group and high-fat and calorie-diet combined with pneumonia group, the intercellular junction of colon mucosa epithelial cells was loose, the cells’ gap was widened, the colon mucosa epithelial cells exhibit a low-density bright band, while the microvilli were shortened and sparse in disorderly and unsystematic directions, the surface of microvilli had no cell membrane. The ultrastructure pathological changes of colon tissue in Yinlai decoction group were improved; the intercellular junction was loose, the cells gap and low-density bright band were significantly narrowed compared to the pneumonia group. In the dexamethasone group, the intercellular junction of colon mucosa epithelial was loose, the cells gap was widened, and the colon mucosa epithelial cells illustrated a low-density bright band, and the microvilli were shortened. Conclusions: Yinlai decoction can reduce the pathological permeability of intestinal mucosa. It may be associated with improving the intestinal mucosal histomorphology and maintaining the integrity of cell connection and microvilli structure. Dexamethasone could significantly relieve pulmonary inflammation but concurrently causes intestinal mucosal tissue damages. (3555) Impact of a Brief Mindfulness-based Stress Reduction Program for First Semester Nursing Students Catherine Kelleher, ScD, MPH, MS, RN1 and Lynn Chen, PhD1 1Baltimore, Maryland Abstract Purpose: There is increasing evidence that brief mindfulness-based stress reduction (MBSR) programs reduce stress, but few studies have tested their impact on nursing students and none on their grades. A randomized intervention pilot evaluated impact of a brief MBSR program for Fall 2012 first semester baccalaureate students in nursing (BSNs) and was repeated for Spring 2013 first semester BSNs. The intervention group received an MBSR program of 4 weekly 1-h classes and 10 min of daily practice; the controls received a 4-h MBSR workshop at the beginning of their second semester. All completed electronic surveys at baseline, 4, and 8 weeks. Results: In Fall 2012, the intervention group had significantly lower stress and higher resilience and mindfulness scores than controls at 4 and 8 weeks, and a significantly higher mean grade in the practice fundamentals course; there were no differences in grade point average. In Spring 2013, there were no differences between groups. Conclusions: Results suggest that a brief MBSR program builds stress management skills and has potential to improve academic performance of first semester BSNs. (3559) Integrating Chiropractic Care Into a Neurorehabilitation Hospital: A Descriptive Study W Carl Cooley, MD1, Lance Donna Gosselin, PT2, Christine M Corber, MSITM3, Robert D Goertz, DC, PhD3, Stacie A Vining, DC3 and Salsbury, RN, PhD3 1Dartmouth College, Concord, New Hampshire 2Crotched Mountain Specialty Hospital, Greenfield, New Hampshire 3Palmer College of Chiropractic, Davenport, Iowa Abstract Purpose: Inpatient rehabilitation for individuals suffering complex neurological injury commonly includes a multidisciplinary approach. However, the role of chiropractic care in such settings is unknown. This study describes chiropractic care integrated into a specialty hospital focused on inpatient rehabilitation for patients with brain injury, spinal cord injury, stroke, and other neurological conditions. Results: The mean (standard deviation) age of 27 participants was 42.8 (13) years (range 20–64 years). Male patients (n = 18; 67%) and persons of white race/ethnicity (n = 23; 85%) comprised the majority. Most participants (n = 20) suffered brain injury from trauma (n = 9), nontraumatic hemorrhage (n = 7), infarction (n = 2), and general anoxia (n = 2). Three participants suffered complete or incomplete cervical spinal cord injury. Common secondary diagnoses included myospasm (n = 13), depression (n = 11), anxiety (n = 10), dysphagia (n = 8), substance abuse (n = 8), and candidiasis (n = 7). The most common chiropractic procedures employed, by percentage of visits, were manual myofascial therapies (93%), mechanical percussion (83%), manual muscle stretching (75%), and thrust manipulation (65%) to address spinal-related pain (n = 15; 54%), joint or regional stiffness (n = 14; 50%), and extremity pain (n = 13; 46%). Care often required adapting to participant limitations or conditions, such as the need for lift assistance, wheelchair dependence, contractures, impaired speech, quadriplegia/paraplegia, and the presence of feeding tubes and urinary catheters. Conclusions: Chiropractic services were successfully integrated into an inpatient setting caring for patients with significant functional limitations and comorbidity. This study also identified care challenges not commonly encountered in outpatient settings where chiropractic services are typically available. (3560) Traditional, Complementary, and Alternative Medicine for Treatment of Atopic Eczema in Children Under 13 Years: A Systematic Review of Randomized Clinical Trials Chun-li Lu, Xue-han Master1, Agnete E Liu1, ArneJohan Kristoffersen2, Frauke Norheim2, Terje Musial2, Vinjar Araek2, Jian-ping Fonnebo2, Trine Liu3, 4 and Stub, PhD2 1Beijing University of Chinese Medicine, Beijing, China 2The National Research Center in Complementary and Alternative Medicine, Tromso, Norway 3Beijing University of Chinese Medicine, Beijing, China 4The Arctic University of Norway, Tromsø, Norway Abstract Purpose: To evaluate the beneficial effect and safety of traditional, complementary, and alternative medicines (TCAM) for children under 13 years with atopic eczema (AE). Results: One hundred eleven randomized clinical trials (RCTs; involving 8797 children with AE) were included (Figure 1). The methodological quality was of unclear risk of bias in general (Figure 2). The trials tested 53 different types of TCAM for children with AE. For clinical effectiveness (defined as 50% global symptom improvement like itch, skin lesions, swelling, and papula), 36 trials showed better effect from TCAM (risk ratio [RR] 1.37, 95% confidence interval [CI] 1.24–1.52) in addition to usual care, and 59 trials showed better effect from TCAM alone (RR 1.33, 1.28–1.37) compared with usual care, and 2 trials showed beneficial effect from TCAM (RR 0.92, 0.70–1.20) compared with placebo. For 6-month follow-up, 9 trials reported lower relapse rate from TCAM + usual care (RR 0.31, 0.23–0.42) comparing with usual care, and another 9 trials reported lower relapse rate from TCAM alone (RR 0.41, 0.21–0.82) compared with usual care. Nine trials reported nonserious adverse events in relation to TCAM. Conclusions: TCAM may reduce symptoms and the relapse rate in children with AE. The safety of TCAM remains unclear due to insufficient reporting. Well-designed, adequately powered, and further rigorous RCTs are warranted. (3561) How Stakeholder Input Shaped a Patient-Centered Outcomes Research Institute-funded Study of Acupressure to Decrease Symptoms During Treatment for a Childhood Cancer Anne Lown, DrPH1, Melissa Martin, RN, MSN, CPNP, CPON2, L Lee Dupuis, RPh, PhD1, Diane Sabin, DC1, Christina Mangurian, MD1, Alison Olig, JD3 and Frederick M Hecht, MD1 1San Francisco, California 2Patient Advocacy Committee, Children’s Oncology Group, Atlanta, Georgia 3Patient Adovocacy Committee, Children’s Oncology Group, Tulsa, Oklahoma Abstract Purpose: To describe the process of stakeholder engagement in the development of a Patient-Centered Outcomes Research Institute-funded study testing an acupressure intervention to decrease treatment-related symptoms in children in treatment for a childhood cancer. Results: Stakeholder input significantly influenced the final study design including changing the primary outcome from pain to nausea/vomiting, including a wider age range (5–21 years), adding inclusion of children with brain tumors (malignant and nonmalignant), incorporating parents as providers of acupressure (in addition to professionally provided acupressure), use of acupressure rather than acupuncture, and the use of a pragmatic comparative effectiveness study design that emphasized an intervention comparision representing a “real life” context (not using sham treatment). Stakeholder feedback often dovetailed with systematic reviews related to the importance of addressing patient symptoms and best advice for acupuncture research. Conclusions: Inclusion of a widely representative group of stakeholders led to significant changes in the study design and measures. Stakeholder feedback will be continually incorporated throughout the study to ensure that study implementation and results addresses stakeholder need, that analysis approaches are meaningful, and that the likelihood of disseminating the study findings to additional pediatric cancer treatment centers will be maximized. (3562) Comparative Impact of Brief Mindfulness-based Compassion and Mindfulness-based Stress Reduction Programs on Stress Management and Grades of First Semester Nursing Students Lynn Chen, PhD1 and Catherine Kelleher, ScD, MPH, MS, RN1 1Baltimore, Maryland Abstract Purpose: A 2-year randomized intervention pilot study during 2014–2016 evaluated if brief mindfulness-based compassion (MSC) and mindfulness-based stress reduction (MBSR) programs would have comparable outcomes in reducing stress and boosting resilience, mindfulness, self-compassion, and academic performance of fall and spring first-semester baccalaureate students in nursing (BSNs). The MSC program was expected to do better because it emphasized self-kindness. During year 1, participants were randomized to MBSR and MSC programs as originally planned but enrollment was low. During year 2, the randomized design was modified to drop the MBSR arm, focus only on the MSC program, and use a control group in which participants would get the MSC program in a consolidated half-day program at the beginning of the following semester. The simplified design permitted testing student interest in signing up for an MSC study and the impact on enrollment if there was no uncertainty about being randomized to 1 of 2 programs which met at different times. Enrollment continued to be low. Results: In year 1, total recruitment = 19, total withdrawal = 8, and 11 of the 11 participants completed all surveys (baseline, 4 and 8 weeks), yielding an analytic sample = 11. In year 2, total recruitment = 22, total withdrawal = 9, and 9 of the 13 participants completed all surveys, yielding an analytic sample = 9. Due to small sample size, analysis for both pilot years was limited to descriptive statistics, and hypotheses could not be tested; however, descriptive analysis indicated that MSC program participants had greater reductions in stress and greater increases in resilience, mindfulness, and self-compassion than did participants in the MBSR and control groups. Conclusions: Despite the brevity of the MBSR and MSC programs, both delivered via 4 weekly face-to-face 1-h sessions, and 10 min of daily at home practice, the format was not feasible due to competing demands for student time, including scheduled classes, labs, and clinical assignments, and support services students were urged or required to use. An online format may not be the answer to the face-to-face scheduling conflicts and other competing demands, but it is an option worth exploring via future pilot studies. (3563) Exploring Mechanisms of Tai Chi for Improving Quality of Life and Depression Symptoms in Heart Failure Patients Roger B Davis, ScD1 M Peter, Gloria Wayne, PhD2, Christina M Yeh, MD, MPH1 and Luberto, PhD1 1Boston, Massachusetts 2Brigham and Women’s Hospital, Boston, Massachusetts Abstract Purpose: Many heart failure patients report elevated depression symptoms and poor quality of life (QoL). Our randomized controlled trial previously showed that Tai Chi exercise improves these outcomes in heart failure patients, but the mechanisms are unclear. As a group-based exercise, Tai Chi may improve social support and behavioral activation (eg, general activity levels, independent of intensity or caloric expenditure), 2 key factors that reduce depression symptoms. We explored whether Tai Chi is associated with greater improvements in social support and behavioral activation (amount of activity, frequency of activity) as compared to an active control, and whether changes in these variables are correlated with improved depression symptoms. Results: Amount of activity (ie, number of activities completed in the past month) decreased in the control group (ΔM = −1.26) but remained stable in the Tai Chi group (ΔM = 0.36; group by time interaction P = .02). There was a trend for greater improvements in activity frequency (ie, number of times various activities were preformed in the past month) in the Tai Chi group (ΔM = 17.89) compared to the control group (ΔM = 13.11; group by time interaction P = .06). Activity changes were not correlated with changes in depression or QoL (P’s > .05). For social support, there was no significant group by time interaction (P > .05), but individual-level increases in social support were correlated with decreased depression symptoms for Tai Chi participants (r = −.32, P = .03). Conclusions: Tai Chi may protect against declines in activity levels, and increases in social support may play a role in Tai Chi-related improvements in depression symptoms. (3570) Use of Heart Rate Variability to Measure the Treatment Effects of an Integrative East-West Encounter: A Pilot Study Devon J Carter1, Andrew Shubov1 and Annie Zhang1 1Santa Monica, California Abstract Purpose: The effects of complementary and alternative medicine (CAM) therapies are difficult to measure because they are often used to treat subjective experiences such as pain. Autonomic tone reflects the intensity of chronic pain conditions, and so heart rate variability (HRV) analytical tools offer potential objective measures of the effects of CAM therapies on pain. We aimed (1) to investigate whether HRV markers can be used to quantitatively measure the effects of CAM modalities at the University of California, Los Angeles Center for East-West Medicine (CEWM) by comparing the HRV before and after therapeutic interventions during a routine patient visit. We also attempted (2) to use this method to identify differences in effect among the interventions (provider encounter, trigger point injections, acupuncture, and massage). Results: Root mean square of successive differences (RMSSD) decreased from 15.81 ms to 22.00 ms (P = .0015), and low frequency/high frequency (LF/HF) decreased from 6.98 to 3.43 (confidence interval [CI] 95%, P = .0096) when comparing the pre- and posttreatment recordings across all patients (n = 20). Patients reporting severe pain (n = 9) demonstrated more robust reductions in LF/HF from a higher baseline of 8.82 to 4.58, while the LF/HF ratio of relatively healthier patients (n = 10) dropped from 2.41 to 1.59. All CAM modalities tested produced similar changes in RMSSD and LF/HF. Conclusions: HRV measurements of RMSSD and LF/HF may be a valid tool for measuring the treatment effect of CAM modalities. Patients in severe pain seemed to have a more pronounced effect. (3571) Study on the Mechanism of Wumei Pill in Treating Pancreatic Neoplasms With the Method of Network Pharmacology Jinchang Huang, PhD1, Zeyu Liu1, Ming Yang1 and Yuxiang Wan1 1Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: Because of its high lethality rate, low 5-year survival rate, and poor clinical efficacy, pancreatic neoplasms pose a great threat to human health. Wumei Pill, a Chinese herbal formula, plays a positive role in treating pancreatic neoplasms by effectively alleviating pain, improving appetite, promoting quality of life, and extending the median survival of patients. To explore the potential antineoplasm targets and mechanism of the treatment of Wumei Pill on pancreatic neoplasms, through analyzing the prescription of Wumei Pill with the method of network pharmacology, in order to provide targeted guidance for the following study. Results: A total of 42 significant target points of Wumei Pill treating on pancreatic neoplasms were found, 114 cellular biological processes were processed through GO biological process (GO_BP) enrichment analysis (P value < .01), and 27-related pathways were carried on by Kyoto Encyclopedia of Genes and Genomes (P value < .05), which mainly including hypoxia-inducible factor 1 signaling pathway, tumor necrosis factor signaling pathway, PI3K-Akt signaling pathway, mitogen-activated protein kinase signaling pathway, NF-kappa B signaling pathway, vascular endothelial growth factor signaling pathway, Ras signaling pathway, and so on. Conclusions: The intervening of a complex multiple-target points pathway may account for the effect of Wumei Pill in treating pancreatic neoplasms. This study not only makes a contribution to a better understanding of the anti-pancreatic neoplasms mechanism of Wumei Pill but also proposes a strategy to develop new Traditional Chinese Medicine candidates at a network pharmacology level. (3572) The Clinical Research on the Association Between Gastrointestinal Heat Retention Syndrome and Pharyngeal Microbiome Disturbance in Children Yuxiang Wan1, Yunhui Wang, MD1, Xueyan Ma, MD1, Fei Dong, PhD2, Xiaofei Li, MD3, Zian Zheng, PhD1, Jianhua Zhen, PhD4, Xiaohong Gu, MD1, He Yu, PhD1 and Tiegang Liu, PhD1 1Beijing University of Chinese Medicine, Beijing, China 2Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China 3People’s Hospital of Leling City, Dezhou, China 4China-Japan Friendship Hospital, Beijing, China Abstract Purpose: Gastrointestinal heat retention syndrome (GHRS) is a syndrome that is associated with increased gastrointestinal heat caused by a metabolic block in energy, especially in children. Symptoms are intolerance to heat, dry mouth, a preference for cold drinks desire, swift digestion with increased apatite, dry and smelly stool, a reddened tongue with yellow fur, and so on. Our teamwork has showed that GHRS plays an important role in the development of respiratory and digestive diseases. This is a pilot study to explore the association between GHRS and pharyngeal microbiome disturbance in children by detecting the throat swab specimens with high-throughput sequencing testing method. Results: Ten GHRS children and 10 healthy children were enrolled, then 20 throat swab specimens were collected from the participants. The pharyngeal microbiome which was annotated included 15 phyla, 24 classes, 56 orders, 90 families, 124 genus, and 58 species. There was no significant difference between 2 groups in microbial diversity. However, the relative abundance of Lactobacillaceae and Lactobacillus was significantly increased in GHRS children. The specific pharyngeal microbiome indicators of children with GHRS was OTU_353 which was annotated as p__Firmicutes, c__Clostridia, and o__Clostridiales statistically. Conclusions: GHRS may have an association with pharyngeal microbiome disturbance in children. And large sample size is needed in the future. (3576) Self-administered Acupressure Improves Co-occurring Symptoms in Fatigued Cancer Survivors Suzanna Zick, ND, MPH1, Richard E Harris, PhD1, Afton Hassett, PhD1, Gwen Wyatt, PhD, RN, FAAN2, Ananda Sen, PhD1, Susan Murrphy, ScD OTR1, J Todd Arnedt, PhD1 and Andrew Schrepf, PhD1 1Ann Arbor, Michigan 2Michigan State University, East Lansing, Michigan Abstract Purpose: Cancer-related fatigue is a prevalent and troublesome symptom in breast cancer survivors (BCS). In a clinical trial, we demonstrated that self-administered acupressure improved fatigue and sleep quality; however, how self-administered acupressure impacted other common symptoms that co-occur with fatigue including pain, anxiety, and depression has not been investigated. Results: RA and SA both significantly improved anxiety (RA vs UC, mean difference: −1.87, 95% confidence interval [CI]: −3.66 to −0.09, P = .34/SA vs UC, mean difference: −1.83, 95% CI: −3.56 to −0.10, P = .037), pain interference (RA vs UC, mean difference: −1.10, 95% CI: −1.93 to −0.27, P = .010/SA vs UC, mean difference: −1.36, 95% CI: −2.23 to −0.48, P = .003) and pain severity versus UC (RA vs UC, mean difference: −1.56, 95% CI: −2.49 to −0.63, P = .001/SA vs UC, mean difference: −1.41, 95% CI: −2.38 to −0.43, P = .005). Only for depression, there was a significant difference between RA and SA (mean difference: −1.99, 95% CI: −3.78 to −0.20, P = .024) and for RA versus UC (mean difference: −2.99, 95% CI: −4.79 to −1.18, P < .001). There was no difference between SA and UC (P = .502). Conclusions: Six weeks of both acupressure protocols were equally helpful in relieving anxiety and chronic pain compared to UC. RA seemed to perform better than SA and UC in this population in reducing depressive symptoms. These results could help clinicians personalize care depending on which symptoms are reported by cancer survivors. (3577) Is Less More? A randomized Comparison of Home Practice Time in a Mind–Body Program Tosca Braun, MA1, Marissa L Schneide, BA2, Lucy Finkelstein-Fox, BA1, Lisa A Conboy, ScD3, Elizabeth D Schifano, PhD1 and Jonathan Greenberg, PhD2 1University of Connecticut, Storrs, Connecticut 2Massachusetts General Hospital, Boston, Massachusetts 3Boston, Massachusetts Abstract Purpose: Home practice is a major component of mind–body programs. However, previous studies assessing the effects of home practice have relied solely on observational/correlational methods, making it extremely difficult to draw causal conclusions about its role in clinical outcome. Moreover, little is known about how to optimize the amount of prescribed home practice in order to achieve an effective “dose” of practice while minimizing participant burden. The primary aim of the current study was to determine how systematically varying the amount of home practice impacts compliance and stress reduction among individuals undergoing a 12-week yoga program. Secondary aims of the study were to examine whether increasing partipants’ amount of flexibility in home practice would increase compliance and to identify predictors of compliance. Results: The low practice group exhibited the highest compliance (91%) compared to the medium and low practice groups (∼60%), but also exhibited the lowest total practice time, and did not significantly reduce stress. The high practice group was the only group to achieve significant reductions in stress, which were maintained 12 weeks after program completion. Allowing flexibility did not increase compliance. Baseline levels of self-efficacy and self-control predicted home practice compliance regardless of prescribed dose. Conclusions: Assigning less home practice boosts compliance but does not yield significant stress reduction. Additionally, compliance can be predicted by levels of self-efficacy and self-control, but compliance is not impacted by assigning a flexible home practice regimen. (3584) Integrative Medical Group Visits: A Randomized Controlled Trial in Patients With Chronic Pain and Depression in a Diverse Urban Setting Man Luo, MPH1, Salvatore D'Amico, BS1, Paula Gardiner, MD, MPH1, Katherine A Gergen-Barnett, MD1, Laura F White, PhD1, Suzanne E Mitchell, MD1, Robert B Saper, MD, MPH1 and Anna S Lestoquoy, MPH1 1Boston, Massachusetts Abstract Purpose: Medical group visits and mindfulness techniques provide a promising adjunct to chronic pain treatment, especially for underserved patients who have limited access to nonpharmacological care. Results: One hundred fifty-nine patients were enrolled and randomized (intervention n = 76; control n = 79). The average age was 51 years, 86% female, 58% identify as black, and 23% as other race. The average income was $5,000–$29,999 with 42% on work leave or disability. The study demonstrates that Integrative Medicine Group Visits (IMGVs) are (1) in demand (nearly 400 patients asked to participate); (2) feasible (94% intervention participants attended the IMGV, 72% attended half or more sessions); (3) valuable to patients (88% of patients attended the IMGV had high satisfaction). In the intention-to-treat analysis, at 21 weeks, there was a reduction in depressive symptoms (risk ratio [RR]: 0.89, 95% confidence intervals [CIs]: 0.75–1.06) and average pain (RR: 0.98, CI: 0.88–1.08) compared to control group. At 21 weeks, for participants who attended 5 or more sessions, there was a 30% reduction in depression (RR: 0.70, CI: 0.53–0.92) and a 20% reduction in average pain (RR: 0.80, CI: 0.67–0.95). At 21 weeks, there was a significant reduction in pain medication use (odds ratio: 0.42, CI: 0.18–0.98); and at 9 weeks, there was a significant reduction in total emergency department visits (RR 0.32 95% CI: 0.12–0.83) between intervention and controls. Conclusions: Our results suggest that IMGV is an option to increase nonpharmacological strategies for low-income racially diverse patients with chronic pain and depression. (3585) Evaluation of the Potential of Tai Chi/Qigong Exercises for Treatment of Low Back Pain by Electromyography, Laser Doppler Flowmetry, and Machine Learning Jacqueline Nguyen, BS1, Sam L Herring, BS1, Jackson K Tran, BS1, Shin Lin, PhD1, Yu Tsao, PhD2 and Payton Lin, PhD2 1Irvine, California 2Academia Sinica, Taipei, Taiwan, ROC Abstract Purpose: Animal studies have shown that stretching reduces inflammation/pain of the lower back, a problem prevalent in humans. This pilot study tests a combination of technologies for evaluation Tai Chi/Qigong stretching exercises for potential treatment of this condition. Results: The 9 Tai Chi/Qigong movements tested showed different levels of muscle activation recorded at the lower and upper back. Most illustrative are electromyographic data showing moderate activity at the upper back and strong activity at the lower back for “Deer Sprinting,” while the opposite was obtained for “Tiger Pouncing” (both from 5 Animals Frolic Qigong). Activities were moderate at both places for “9 Ghosts Drawing Saber” (from Tendon Changing Classic Qigong). Blood perfusion data were consistent with these patterns: 34.7 ± 3.0 (mean increase ± standard error mean, arbitrary units) for upper back, 66.1 ± 11.6 for lower back for deer, 50.9 ± 3.8 and 39.2 ± 4.9 for tiger, and 37.5 ± 2.9 and 48.8 ± 11.2 for ghosts. Conclusions: This study shows that the methodology used is promising for evaluating the extent Tai Chi/Qigong movements might be effective for stretching the lower back for relieving inflammation/pain. (3586) Development of an Inpatient Integrative East-West Medicine Consultative Service Annie Zhang1 and Andrew Shubov1 1Santa Monica, California Abstract Overview: Background: Integrative Medicine (IM) provides a range of therapeutic treatment options for patients who are refractory to the medical care available in the hospital. Unfortunately, the challenges of building a sustainable inpatient IM program limits the availability of these services for patients and keeps many physicians unaware of the potential value of IM. Bringing IM services into the hospital setting would be a major step forward in the integration of IM into mainstream medical culture. The University of California, Los Angeles (UCLA) Center for East-West Medicine (EWM) offers Traditional Chinese Medicine inspired lifestyle counseling and treatment options to outpatients in the UCLA health system. Our clinical experience has shown that EWM can also be used in the inpatient setting to successfully break the recurrent readmission cycles of chronic abdominal pain and other refractory pain syndromes. Program Description: We are launching a full-time inpatient integrative EWM consult service to test the concept that IM consultants can work alongside other medical subspecialties as part of an inpatient treatment plan as well as to develop a sustainable inpatient financial model to provide EWM services while minimizes costs to patients. Our first aim is to develop a consultative service that integrates into the inpatient treatment team for complicated hospitalized patients. Following the initial physician consultation, IM-informed recommendations will be offered and evidence-based EWM services such as acupuncture will be provided as part of the medical treatment plan. Our second aim is to evaluate the physician consultative service as a financial model for a sustainable inpatient IM program with minimal cost to the patient. Revenue will be generated primarily from evaluation and management coding, as well as occasional procedures such as trigger point injections, without billing for noncovered acupuncture services. Conclusion: This program will test the feasibility and preliminary clinical effects of an inpatient Integrative East-West consultative service. Rationale: Bringing IM services into the hospital setting would be a major step forward in the integration of IM into mainstream medical culture. The Mission of the Consortium is to advance IM and health through academic institutions and health systems, and the conference more specifically discusses advancing IM through collaboration. This clinical initiative represents a direct advance of IM into the inpatient academic health-care setting through direct collaboration with the inpatient treatment teams. Objectives: Participants are intended to gain an understanding of the upcoming UCLA East-West Medicine inpatient consult service and of the financial model we plan to employ. More broadly, participants are encouraged to consider inpatient IM services in the treatment of complex hospitalized patients. (3590) Resiliency in Medical Students: Contributing Factors Laura Malosh, PhD1, Emily Moss, BS1, Sian Cotton, PhD1 and Harini Pallerla, MS1 1Cincinnati, Ohio Abstract Purpose: Increasing resiliency in medical students is a key factor in promoting wellness during the rigors of medical school. The purpose of this study was to examine mental and emotional factors related to resiliency as a target for future resiliency programming. Results: Six hundred eighty-three students (F = 49.3%; White = 65%; mean age = 24) completed the survey (response rate >95%). HR students across all years (80.1%) scored better on most measures as compared to their LR peers (P < .05). Higher mindfulness (B = .093), more positive affect (B = .063), less stress (B = −.222), and less anxiety (B = −.066) were associated with higher resilience (R2 = .409). In qualitative responses, students identified creating a plan and gaining perspective as key to improved resiliency. Students reported that their resiliency could be increased with more free time, mentorship, and better access to wellness resources at school. Conclusions: Resilience in these medical students was related to increased mindfulness and better mental health. Most students reported high levels of personal resiliency and identified feasible targets for school enhancement of resiliency. Developing resiliency programs that emphasize mindfulness while reducing stress of medical students should be prioritized. (3596) Sibley Memorial Hospital’s “Poets-in-Residence” Program NP Harpreet Gujral1 and Frankie Abralind, BS, MBA2 1Sibley Memorial Hospital, Washington, DC 2Sibley Memorial Hospital Innovation Hub, Washington, DC Abstract Overview: At Sibley Memorial Hospital, a community hospital in Washington, DC, “Poets in Residence” (PiRs) write custom poems for patients, staff, and visitors. They make themselves available at designated locations and engage one-on-one with any curious person who comes up to talk. Trained by experienced street poet and experience designer Frankie Abralind, they solicit a topic, ask a few probing questions, then compose an original poem which they hand off to the recipient a few moments later. Themes range from hope and gratitude to romantic discord and the anguish of grief. Poets have long provided a service of helping people understand emotions, experiences, and defining moments in life. A poem can shed unexpected light on a situation and make connections that are not otherwise obvious. It can reassure the reader. It can help someone get through a difficult time, giving comfort in suffering. Finding one’s voice via poetic means can be a healing process because it opens up the opportunity for self-expression not otherwise felt through everyday words. To ensure sustainability of the program, our train-the-trainer program allows current PiRs and alumni of the program to train future poets. Rationale: The arts and humanities have an established benefit for healing. Art therapy can reduce reliance on painkillers, lower average duration of hospitalization, and improve recovery times. Our PiR program helps the hospital address people as humans first, and recognizes their medical experience as more than just corporeal. This supports Sibley Memorial Hospital’s mission, “To deliver excellence and compassionate care– every person, every time.” Initial studies indicate that a poetry therapy intervention may improve emotional resilience and anxiety levels in cancer patients. Because the goal of integrative medicine is to bring together various healing modalities into contemporary medicine, we offer this program as great opportunity for low-cost, nonpharma benefit in this era of human disconnection and medical crises like America’s opioid epidemic. Findings from numerous experiments have suggested that writing exercises can give a whole array of health benefits including reductions in emotional and physical health complaints, and enhanced social relationships and role functioning. Objectives: The aim is to showcase Sibley’s innovative program, provide an example other hospitals and health systems can emulate, and elevate the perception of the arts in healing. (3597) Dose–Response Effects of Tai Chi and Physical Therapy Exercise Interventions in Symptomatic Knee Osteoarthritis Xingyi Han, MPH1, Jeffrey B Driban, PhD, ATC, CSCS1, Maura D Iversen, SD, DPT, MPH2, William F Harvey, MD, MSc1, Augustine C Lee, MD1, Lori L Price, MAS, MLA1, Chenchen Wang, MD, MSc1 and Raveendhara R Bannuru, MD, PhD1 1Tufts Medical Center, Boston, Massachusetts 2Northeastern University, Boston, Massachusetts Abstract Purpose: While exercise is the recommended nonpharmacological treatment for knee osteoarthritis (OA), optimal treatment dose, and clinically meaningful treatment durations remain unclear. We examined dose–response relationships, minimum effective dose, and baseline factors associated with timing of response from 2 exercise interventions among adults with knee OA. Results: We examined 182 participants (mean age 61 years, BMI 32 kg/m2, 70% female, 55% white). Both interventions had linear dose–response effects resulting in a 9- to 11-point reduction in pain and 32- to 41-point improvement in function per week. There was no difference in overall time-to-response for pain and function between treatment groups (Figure 1). Median time-to-response for ≥20% improvement in pain and function was 2 attendance-weeks and 4 to 5 attendance-weeks for ≥50% improvement. In unadjusted models, we found a general pattern wherein physical health, self-efficacy, and outcome expectations tended to be associated with treatment response rather than psychosocial or biomechanical factors (Table 1). In multivariable models, outcome expectations were independently associated with incident function response (Hazard Ratio: 1.47; 95% CI: 1.004 to 2.14). Conclusions: Both interventions had linear dose-dependent effects on pain and function, and minimum effective doses ranged from 2 (≥20% improvement) to 5 weeks (≥50% improvement). Patient-perceived benefits of exercise independently influenced timing of response among adults with knee OA. These results may help clinicians optimize patient-centered exercise treatments and better manage patient expectations. (3606) Seven Years of Patient Data at an Acupuncture and Oriental Medicine Teaching Clinic—A Retrospective Analysis Ben Marx, MAcOM1 1Oregon College of Oriental Medicine, Portland, Oregon Abstract Purpose: Analyze data for patients treated at the Oregon College of Oriental Medicine between 2009 and 2016. Results: A cohort comprising 6820 patients was analyzed. The majority were white (64%) and female (68%). Average age was 45.5 (SD 16.95). At visit 1, 56% reported prior acupuncture treatments and confidence (71%) that treatment would be effective. Fifty-five percent self-report chief complaint as pain and 75% report pain as a comorbidity. Fifty-one percent report chronicity of chief complaint as “1 year or more;” 26% report “5 years or more;” and 38% report taking prescription medication for their chief complaint. For those taking medication, 60% report cutting down medication is “very important” or “a bit important.” For those not taking medication, 55% report avoiding medication is “very important” or “a bit important.” From visit 1 to visit 5, patients report 1.38 point average improvement in severity of chief complaint, 1.08 point improvement in pain level, and a 1.25 point improvement in activity interference. Small, nonsignificant improvements were reported in well-being and QOL. Conclusions: Pain conditions constitute the overwhelming majority of visits to the OCOM clinic. Patients utilize services primarily for chronic conditions, and majorities do so with the goal of reducing or avoiding medication. After 5 treatments, regardless of chief complaint, patients report modest but clinically meaningful improvements in symptom severity, pain level, and activity interference, suggesting that intern-delivered AOM is an effective short-term intervention for a spectrum of health concerns, particularly chronic pain. Future studies should examine long-term patient outcomes in similar settings. (3615) Safety of Custom Traditional Chinese Herbal Medicine Practice at Cleveland Clinic Galina V Roofener, LAc1 1Cleveland, Ohio Abstract Purpose: The goal of this study is to evaluate the safety of Traditional Chinese Herbal Medicine (TCHM) practice at CC CILM. Results: Over 24 months, 206 patients received 1245 prescriptions, totaling 68 379 doses and199 640 grams. Patients were reevaluated in person on an as-needed basis. Detailed treatment progress, adverse event, and hospitalizations were documented in the patient’s EMR. In the event of any unusual symptom or allergic reaction, patients were instructed to contact a provider. A complete metabolic panel (CMP) collected at a baseline, 4 to 8 weeks and 6 months of herbal intake was used to evaluate safety. CMP results did not detect changes that could be attributed to herbs. Patients reported 3 cases (1.5%) of mild adverse effects which includes anxiety, nausea, and pruritus. All events were reported to The State of Ohio Medical Board according to Ohio law but none required FDA reporting. Conclusions: This study illustrates THCM as practiced at CC CILM is likely to be safe. This includes TCHM formulas compounded from concentrated 5:1 water-decocted extract granules manufactured according to ISO/IEC 17025:2005 testing lab international standards, compounded according to FDA regulation Title 21 CFR 111, and prescribed according to TCM principles by a licensed Chinese Herbalist. A prospective, well-controlled trial which includes a larger cohort monitored over a longer period of time is warranted. (3616) Higher Mindfulness Is Associated With Less Pain and Greater Psychological Well-being in Fibromyalgia Emily Wolcott, BA1, Brandon Pleman, BS1, Lori L Price, MAS, MLA1, Jeffrey B Driban, PhD, ATC, CSCS1, Xingyi Han, MPH1, William F Harvey, MD, MSc1, Raveendhara R Bannuru, MD, PhD1 and Chenchen Wang, MD, MSc1 1Tufts Medical Center, Boston, Massachusetts Abstract Purpose: Previous studies show that mindfulness is associated with health outcomes in people with chronic pain, but its impact in individuals with fibromyalgia remains unclear. We examined the associations between mindfulness and pain and psychological outcomes in fibromyalgia patients. Results: We included 177 participants (52.0 ± 12.2 years; 93.3% women; 60.0% white; body mass index: 30.0 ± 6.7 kg/m2; FFMQ: 131.0; FIQR: 57.0). Higher mindfulness was associated with lower fibromyalgia impact (P = .003), pain interference (P < .0001), stress (P < .0001), anxiety (P < .0001), depression (P < .0001), and higher mental health-related quality of life (P < .0001). Of the 5 facets, Describing, Acting-with-awareness, and Non-judging were most significantly associated with pain and psychological outcomes. Furthermore, we did not find that mindfulness significantly moderated the effect of pain interference on psychological outcomes. Conclusions: Higher levels of mindfulness are associated with lower fibromyalgia impact, pain, and better psychological health and quality of life in people with fibromyalgia. Future studies should assess how mind-body therapies increasing mindfulness may improve the well-being of patients with fibromyalgia. (3617) A Few More Chiropractic Doctors: A Qualitative Study of Stakeholder Perceptions of Access to Chiropractic Care in Veterans Affairs Health-care Facilities Christine M Goertz, DC, PhD1, Anthony J Lisi, DC2, Robert B Wallace, MD, MSc3, Stacie A Salsbury, RN, PhD1 and Robert D Vining, DC1 1Palmer College of Chiropractic, Davenport, Iowa 2Connecticut VAHCS, West Haven, Connecticut 3The University of Iowa, Iowa City, Iowa Abstract Purpose: Veterans experience high rates of musculoskeletal disability, with low back pain (LBP) among the most common reasons for seeking care within Veterans Affairs (VA) health-care facilities. This study explored VA stakeholder perceptions of patient access to chiropractic care. Results: All stakeholder groups reported a perceived need for chiropractic care within VA based on veterans’ high LBP symptom burden and susceptibility paired with the efficacy of chiropractic for many LBP complaints. Actual and/or perceived access to chiropractic services were limited by geographical distances to clinics, temporal issues around appointment wait times, and financial barriers of service-related eligibility. Some stakeholders noted cultural concerns from biases toward the chiropractic profession and issues of gender/ethnicity/language concordance between patients and providers. Telehealth technology which has increasing application in VA primary care and mental health settings, was questioned for hands-on, manual therapies. Patients perceived access issues related to chiropractic dose, including the lack of ongoing care for chronic LBP and beliefs that shorter durations of episodic care could worsen LBP severity. Additional chiropractors, increased service availability at more VA locations, removal of gatekeeping structures, and improvements in interprofessional collaboration were suggested solutions to access restrictions. Conclusions: Stakeholder perceptions of chiropractic care suggested expanded access to these services for veterans with LBP. Future research should test the validity of this model of chiropractic access in representative samples. (3619) Management of Allergic Disorders in Child and Adolescent Age-group Through Ayurvedic Dietetic Principles Aparna W Panikkasseril, BAMS, MD1 and Naveen Chandran Venkallil, BAMS, MD (Ay)2 1Indian Systems of Medicine, Kollam, Kerala, India 2Atreya Ayurveda, Moscow, Russian Federation Abstract Overview: The history of dietetics can be traced back to the era of ancient civilizations. During the era of enlightenment when scientific and medical development increased exponentially, the theory of nutrition was redefined based on equations of Chemistry. But in modern era, earlier dietary principles are being peer reviewed based on concepts like endoecology. Child and adolescent age-group allergies are on the rise and considered a modern epidemic. Allergic reactions to common substances represent new risks. Factors associated with westernization, rather than urbanization, probably account for the increase in dietary changes which lead to alteration in internal environment. Ayurveda is a system of medicine which defines normal nutrition and metabolism as a prime indicator of health. It explains in detail the role of impaired metabolism in the etiopathogenesis of diseases. The functional balance of the body is maintained by 3 factors (Dosha) called Vata, Pitta, and Kapha. Dosha represents a group of functions in the body. Kapha when normal provides normal growth and immunity and has prime role in respiratory sytem. Childhood and adolescence being the age of growth and development, Kapha is naturally predominant in this age-group. Ayurveda explains how improper diet and metabolism in children vitiates Kapha, leading to abnormal immune reactions and respiratory disorders. It classifies food products based on their specific properties and what role they have in the etiopathogenesis of diseases. Rule of dietetics prohibits the use of specific food products with respect to 5 factors—Dosha, age, stage of digestion, season, and disease. Thus, the concept of diet in Ayurveda is highly individual and sophisticated which follows dynamic changes in the internal body and external environment. This concept is unique based on specific dietary principles. These principles help to modify the intrinsic factors of allergy with respect to the changes in external environment Rationale: Allergies are on the rise and considered a modern epidemic. Allergic reactions to common substances represent new risks. Factors associated with westernization, rather than urbanization, probably account for the increase in dietary changes with more use of processed foods which lead to alteration in internal environment. The ancient cultures like India, Egypt, and China had highly developed medical systems in practice. These systems in place even before 2000 BC, had defined day-to-day dietary practices of the people in detail. Currently body of evidence is mounting that diet may play an important role in respiratory diseases such as asthma. There have been very few randomized controlled trials, so it is difficult to estimate the effect that these suggestions might have. The concept of diet in Ayurveda is highly individual and sophisticated which follows dynamic changes in the internal body and external environment. These principles can help to modify the intrinsic factors of allergy with respect to the changes in external environment and can provide better outcome. Objectives: The concept of dosha in Ayurveda and its physiology in respiratory system will be explained. The discussion will provide an outlook into the dietary principles of Ayurveda and rules of dietetics in Ayurveda. The etipathogenesis of allergic disorders will be explained based on Ayurvedic parameters. Practical application of Ayurvedic dietetics in the clinical practice of allergic disorders will be explored. (3623) How Effective Is Music Therapy for Chronic Noncancer Pain? A Systematic Review and Meta-analysis Chenchen Wang, MD, MSc1, Raveendhara R Bannuru, MD, PhD1, Ting-An Tsai1, Michelle Park, BA1 and Jan Vagedes, MD2 1Tufts Medical Center, Boston, Massachusetts 2ARCIM Academic Research in Complementary and Integrative Medicine, Filderstadt, Germany Abstract Purpose: Chronic pain affects 33% of the U.S. population. Pharmacological treatment risks adverse events, ineffectiveness, and addiction. Complementary and integrative options are needed. Evidence suggests that music therapy alleviates acute and cancer-related pain. However, its benefits for chronic pain are unknown. We systematically review the preliminary effect of music therapy for chronic pain. Results: Our systematic search yielded 26 relevant studies. Eight studies (published 2002–2016, total n=503, 77% women) met inclusion criteria (Table 1). Mean age was 48 years. Treatment durations ranged from 1 to 16 weeks. Sample sizes varied between 37 and 87. Two studies included patients with fibromyalgia, 1 with osteoarthritis, 1 with low back pain, 1 with primary headache disorders, and 3 with unspecified chronic pain. Six trials compared music listening with usual care, 1 compared vocal music therapy with usual care, and 1 compared vocal music therapy with music listening. Compared with control interventions, music therapy was associated with significant improvement in pain in all 8 studies. Three studies reported improved anxiety and 5 reported improved depression. We found a pooled effect size of −0.58 (95% confidence interval (CI): −1.03, −0.12) for pain favoring music therapy over control (Figure 1(A)). We found significant effects favoring music therapy for depression −0.67(95% CI: −1.15, −0.19) (Figure 1(B)) and anxiety −0.90 (95% CI: −1.66, −0.13) (Figure 1(C)). Conclusions: Music therapy may be effective in alleviating chronic pain. Future studies should be performed to deepen our understanding of this therapeutic modality. (3629) Efficacy of Curcumin and Boswellia for Knee Osteoarthritis: Systematic Review and Meta-analysis Mikala C Osani, BS1, Timothy E McAlindon, MD, MPH1, Raveendhara R Bannuru, MD, PhD1 and Chenchen Wang, MD, MSc1 1Tufts Medical Center, Boston, Massachusetts Abstract Purpose: The unfavorable safety profiles of many of the treatments commonly prescribed for knee osteoarthritis (OA) have led clinicians to seek safer alternatives for symptom management. Research has suggested that curcuminoid and boswellia formulations could impede the action of key inflammatory mediators in early knee OA and block inflammatory pathways associated with disease progression. We conducted a systematic review and meta-analysis to assess the efficacy and safety of these treatments versus placebo or NSAIDs for knee OA. Results: Ten RCTs (N = 875) were eligible for analysis. Study quality was low overall, and most included RCTs were conducted on fewer than 100 participants. Both curcuminoid and boswellia formulations were statistically significantly more effective than placebo for pain relief and functional improvement (Figure 1). There were no significant differences between curcuminoids or boswellia and placebo in safety outcomes. Curcuminoids showed no statistically significant differences in efficacy outcomes compared to NSAIDs; patients receiving curcuminoids were significantly less likely to experience gastrointestinal adverse events. No RCTs compared boswellia against approved NSAIDs. Conclusions: The results of our study indicate that both curcuminoid and boswellia formulations are significantly more effective than placebo in relieving the symptoms of knee OA and do not pose significant safety risks. Generalizability of our results may be limited by the quality and duration of the available RCT evidence. With more robust research, it may be possible to investigate a synergistic effect between curcuminoid or boswellia formulations and other OA treatments. (3630) Outcome Expectations and Fibromyalgia: Perceived Benefits of Exercise Are Associated With Self-Efficacy and Physical Performance Chenchen Wang, MD, MSc1, Raveendhara R Bannuru, MD, PhD1, Jolanta Marszalek, MD1, Gerald Chi, MD2 and Lori L Price, MAS, MLA1 1Tufts Medical Center, Boston, Massachusetts 2Beth Israel Deaconess Medical Center, Boston, Massachusetts Abstract Purpose: Outcome expectancy is recognized as a determinant of exercise engagement and adherence. Higher outcome expectations for exercise (OEE) have been shown to correlate with greater motivation to exercise in patients with osteoarthritis. However, little is known about which factors may influence OEE in fibromyalgia. This is the first study to examine the associations between baseline OEE and demographic, physical and psychosocial variables in patients with fibromyalgia. Results: Participants had a mean age of 51.8 years and body mass index of 30.0 kg/m2, 92.5% were female, 61.1% were white, and 36.0% possessed at least college-level education. Compared to the lower OEE group, individuals with a higher OEE were more likely to have a greater self-efficacy (5.7 ± 2.2 vs 4.8 ± 2.0; P = .001) and physical performance as assessed by 6-min walk distance (meters) (423.8 ± 85.8 vs 382.2 ± 77.6; P < .001) or SF-36 physical component (31.8 ± 7.0 vs 29.6 ± 8.0; P = .029). There were no other significant associations. Conclusions: Our study found that higher OEE was significantly associated with greater self-efficacy and physical performance. Future longitudinal research should explore how these relationships affect long-term exercise engagement for patients with fibromyalgia. (3632) Protocol of a Comparative Effectiveness Feasibility Trial of a Mindfulness-based Intervention for Insomnia Among Breast Cancer Survivors Daniel Lewin, PhD1, Elizabeth Goldberg, LMT2, Gabriella Cifu, MPH2, Mikhail Kogan, MD2 and Hannah Arem, PhD2 1Children’s National Health System/GW School of Medicine, Washington, DC 2Washington, DC Abstract Purpose: Breast cancer survivors suffer from late and long-term effects of cancer diagnosis and treatment, including insomnia. While Cognitive Behavioral Therapy for Insomnia (CBT-I) is considered to be the gold standard to address insomnia, it is not widely accessible to cancer survivors due to limited numbers of practitioners and complicated insurance requirements. This study aimed to compare effectiveness of CBT-I with a mindfulness-based intervention, which included complementary and alternative medicine techniques. We hypothesized that this mindfulness intervention would prove acceptable, be feasible, and improve insomnia symptoms among women who had completed breast cancer treatment. Results: Preliminary results suggest high acceptability of the mindfulness intervention to address insomnia among breast cancer survivors. Among the women enrolled in the first group, participants overall attended 85.7% of the sessions. Early feedback on content indicates more favorable responses to sleep hygiene, breathing techniques, nutrition, yoga, and guided meditation. The study will be completed by March 2018. Conclusions: The results of this study will be used to inform the design of future insomnia intervention efficacy studies among breast cancer survivors to optimize mindfulness-based interventions. (3637) Modeling Spinal Manipulative Therapy for Studies of Analgesia in Chronic Experimental Pain Bradley K Taylor, PhD1, Renee R. Donahue, MS1, Qian Li, MS2, Randall S Sozio, BS2, Danielle M DiCarlo, BS2, Cynthia R Long, PhD2 and Stephen M Onifer, PhD2 1University of Kentucky, Lexington, Kentucky 2Palmer College of Chiropractic, Davenport, Iowa Abstract Purpose: Treatments of low velocity variable amplitude spinal manipulation (LVVA-SM) improve pain in chronic low back pain patients, especially those with neuropathic radiating leg pain following peripheral nervous system insult. Despite the analgesic effectiveness of this nonthrust spinal manipulative therapy, no one has reverse-translated these findings to animal models. The present study addresses this gap using a reductionist approach. Results: SNI produced behavioral signs of mechanical and cold allodynia. LVVA-SM reduced mechanical hypersensitivity as compared to Control LVVA-SM (0.15 Hertz: P = .04 at 10 min; 0.16 Hertz: P < .001 at 10 min, P = .04 at 25 min). LVVA-SM did not change cold hypersensitivity. Conclusions: We reverse-translated the analgesic effect of LVVA-SM in chronic low back pain patients with neuropathic radiating leg pain to an animal model. We will use this model to investigate underlying mechanisms of LVVA-SM analgesia, such as the technique’s components and activity-dependent neurotransmitter systems modulating spinal cord activity. (3640) Meditation and Health, Prospective Case Analysis Study Petere Hudoba, MD1, 2 1Sha Research Foundation, San Francisco, California 2Burnaby, British Columbia, Canada Abstract Purpose: Over last years, researchers are increasingly turning their attention to alternative healing methods like prayer, meditation, Qi Gong, Yoga, reiki, and similar. From our point of view, these techniques have much wider effects on human beings than simply the alleviation of symptoms of illness. We feel that in order to advance the field, it is necessary to use standard medical research instruments that can capture not only the changes in symptoms, but changes documented by medical professionals also. Results: Fifty-five subjects have been observed for past 3 years, 42 of them continued up to the end of the study, 4 has died before end of the study. They have been suffering from various types of illness raging from addiction, psychiatric illnesses, neurologic illnesses up to cancer in various stage. Retrospective analysis of data shows that most of the patients exhibited improvement in general well-being, an increase in optimism and energy level, as well as improvement of their symptoms. Twenty-one (45.6%) reported marked improvement or complete recovery, 16 (34.8%) moderate improvement, 3 (6.8%) minimal improvement, 2 (4.3%) unchanged or continued to deteriorate, and 4 (8.7%) died (terminal cancers and a stroke). Detailed analysis of the data will be discussed during the presentation. Conclusions: The study treatment was well tolerated and no complications arose. The results of this study confirmed efficacy of combining Meditation and Qi Gong healing with conventional medical treatment. (3641) Can Psychological Resilience Decrease Symptoms of Pain and Fatigue? Tej Khalsa, MD, MSc, FRCP1, Cindy Kermott, MD1 and Amit Sood, MD, MSc, FACP1 1Rochester, Minnesota Abstract Purpose: To examine the association of resilience with pain and fatigue in a cross-sectional survey. Results: A total of 3188 survey responses were recorded. The final cohort for this study (n = 1954) comprised participants who were currently employed executives or other business professionals and answered all 10 CD-RISC items. Executives with the highest resiliency scores had the fewest experiences of pain: mean of 2.7 (SD 2.5) for resilience scores less than 30, mean 2.6 (SD 2.6) for resilience scores 30–34, and mean 2.3 (SD 2.5) for resilience scores of 35 or greater (P = .0262). Severity of pain also decreased with increasing resilience scores (mean 2.1 (SD 1.9) for resilience scores less than 30, mean 2.0 (SD 2.0) for resilience scores 30–34, and mean 1.7 (SD 1.8) for resilience scores of 35 or greater; P = .0005). Those with higher resilience scores also experienced less fatigue (mean 4.1 (SD 2.2) for resilience scores less than 30, mean 3.2 (SD 2.1) for resilience scores 30–34, and mean 2.7 (SD 2.3) for resilience scores of 35 or greater; P < .00011). Conclusions: Observational data suggests higher resilience is associated with lower pain frequency, lower pain severity, and lower fatigue. Although this study cannot infer causality, testing the efficacy of resilience training on symptoms of pain and fatigue will be a worthwhile next step, given the prevalence and societal impact of chronic pain. (3642) Incorporate Oriental Medicine Treatment to Conventional Psychiatric Clinic for Secondary Insomnia Yumin Cho, PhD1 and Sanghyun Lee, MS2 1Los Angeles, California 2Insight Choices, West Hollywood, California Abstract Purpose: Insomnia is one of the common side effects of antidepressant. Incorporate oriental medicine to conventional psychiatry practice to reduce secondary insomnia. Results: According to ISI, among 10 patients who have improvement in 1 to 10 visits from 13.5 (subthreshold insomnia) to 6.8 (no clinically significant insomnia) changed from 4 patients to 2 patients with clinical insomnia, 4 to 2 with subthreshold, and 2 to 6 patients without clinical insomnia. 7 patients with medication changed from 15 (clinical insomnia) to 8.1 (subthreshold) while nonpsychiatric medication patients changed from 10 to 3.6. Result from another 4 patients is shown average from 5.6 to 9.8 include 2 with jet lag of international trips, 1 with increased dosage of risperidone from 1 mg to 2 mg, and 1 patient with change career. Conclusions: Oriental medicine include acupuncture, cupping, and recommendation of lifestyle is helpful to decrease insomnia level for patients with medication and without medication. In the future study, outside source that might influence include change medication and dosage, include control group of insomnia without treatment, cortisol level measurement as biomarker, specify types of antidepressant and increase population needs to be included. (3644) Centella Asiatica Extract Improves Cognition in 2 Mouse Models of Alzheimer’s Disease Maya Caruso, BS1, Kirsten Wright, ND, MS1, Joe Quinn, MD1, Don Don Matthews, PhD1, Nora Gray, PhD1, Amala Soumyanath, PhD1 and Christopher Harris, BS1 1Portland, Oregon Abstract Purpose: Centella asiatica (CA) is a traditional botanical medicine believed to enhance memory. We have reported that CA water extract (CAW) protects neuroblastoma cells and primary neurons from beta amyloid (Aβ) toxicity in vitro. The presence of Aβ plaques in the brain are a hallmark pathological feature of Alzheimer’s disease (AD). We therefore examined the effects of CAW on memory in the Tg2576 and 5xFAD transgenic mouse models of AD which develop brain Aβ plaques and show learning and memory deficits. Tg2576 mice develop plaques by 18 to 20 months of age, whereas 5xFAD animals develop them earlier, by 5 to 7 months of age. Results: Untreated Tg2576 animals showed memory deficits compared to WT littermates in both the NORT (P < .01) and CFR tests (P < .05) confirming a genotype effect. CAW (2 mg/ mL) improved memory of Tg2576, but not WT littermates, in both the NORT (P < .05) and CFR (P < .05) paradigms. Untreated 5xFAD mice differed from WT mice in the CFR test (P < .05) but not in the NORT. CAW dose dependently improved behavior of 5xFAD animals in the CFR test at 2 mg /mL (P < .01) and 5 mg/mL (P < .001), but only the higher dose improved memory in WT littermates (P < .05). A nonsignificant trend to improved memory was seen in the NORT for the 5xFAD mice at 5 mg/mL CAW. Conclusions: CAW improved cognition in 5xFAD and Tg2576 mice, supporting its traditional use as a memory enhancer and its potential utility in treating Alzheimer’s Disease. (3645) Combination-guided Meditation and Yoga and Medical Student Stress Reduction Brenna Beck, BA, Sheena MEd1, Delia Patel, BS1, Zofia Chiaramonte, MD1 and Kozak, BS1 1Baltimore, Maryland Abstract Background: Medical students regularly experience high levels of stress related to high-stakes testing, sleep deprivation, and demanding schedules. This places students at particularly high risk for the ill-effects of elevated stress, including depression, substance abuse, and overall deterioration of mental health. The benefits of mindfulness or guided meditation and physical exercise on stress levels are well documented. We hypothesize that self-reported stress in medical students at a U.S. medical school would decrease after participation in combination guided meditation and yoga sessions. Program Description/Teaching Point: An 8-week program of weekly 1-h sessions has been made available to first and second year medical students at a U.S. medical school for the past 2 years, including guided mindfulness meditation combined with yoga practice, led by a physician trained in these techniques. The program, sponsored by the medical student-led Complimentary and Integrative Medicine Interest Group (CIMIG) occurs twice yearly. To date, the efficacy of these sessions in reducing stress among students has not been studied. A simple web-based self-reporting tool has been designed for use in the upcoming program. Participants will be prompted to report relative stress on a 10-point Likert-type scale prior to beginning the program as a baseline, before and after each session, and following the completion of the 8-session program. We hypothesize that self-reported stress among students will decrease following session participation. Conclusion: A combination program of weekly mindfulness meditation and yoga practice for medical students has been implemented; however, the effects of these sessions have not been studied. The student leadership of CIMIG has designed and implemented this project to measure self-reported stress among medical student participants in these stress-reduction activities. (3646) From Cookie Cutter to Compassionate Care: The Story of Innovation and Design to Integrate Care Delivery Across the Hospital Joanne Miller, DNP, RN, NEA-BC1, Caroline Shafa, MHA2 and Harpreet Gujral, NP3 1Sibley Memorial Hospital, Johns Hopkins University, Washington, DC 2Washington, DC 3Sibley Memorial Hospital, Washington, DC Abstract Overview: Through use of cutting edge, design thinking; this hospital is unique with a dedicated physical space for Innovation. Even the mission statement is the byproduct of codesigning, cocreating within various stakeholders including engaging patients, physicians, hospital staff, and leadership. The mission is to deliver excellence and compassionate care—every person, every time. The vision is to be the role model for innovation in health care and wellness for all. By using human-centered design to solve clinical problems/issues while engaging all stakeholders including the patients/family members, several solutions have been achieved by simple process of inspiration, ideation, and implementation in clinical practices. Hospital-wide initiatives to care for patients, families, and staff include “About Me boards” in patient rooms, a Tranquility room for staff, and a meditation garden for patients, families, and employees. Beginning various team meetings and huddles with a 3-min meditation, purposeful optimal healing environment, healthy food options, and employee gymnasium for well-being are ways to enhance compassionate care while using Relationship-based Care model as framework. By implementing these innovative practices to cultivate well-being and resilience among employees; collaboration is constantly stimulated. Interprofessionalism is being promoted via various interprofessional committees to solve clinical problems including managing patient’s symptoms using guided imagery, acupuncture, essential oils, yoga, meditation classes, and so forth. This organically has created a fertile ground for delivering compassionate care as we aim to reduce the opioids use to manage our patients’ symptoms. The human-centered design process along with incorporating various integrative modalities has been the basis for creating and incorporating various ideas to improve the compassionate care delivery model while caring for the team members. We continue to aspire to be the workplace where innovation is the foundation to target wellness for all. Rationale: Clinical innovative initiatives are vital to not only meet the needs of the patients and their loved ones but allow caregivers/health-care providers to stay inspired, passionate, and resilient. Quadruple Aim is no longer a novel concept. It is important to ensure that the clinicians and other health-care workers have resources to learn creative ways for solving routine or complex problems/issues using human-centered design approach and to learn ways for caring themselves while at work. Objectives: The aim is to learn use of human-centered design approach in any setting for solving problems (clinical and systems issues) and be the change agents; experience a quick design sprint to learn this method can be replicated. (time permiting); gain various strategies to solve clinical problems by learning various examples of current practice at this unique hospital with Innovation hub; and learn ways to take care of self and others while at work. (3648) Evaluating Stress Among Medical Students After Combined Physical Activity and Teaching Sessions With School Children Brenna Beck, BA, MEd1 and Jacqueline A Krevitz, BA1 1Baltimore, Maryland Abstract Background: Medical students regularly experience high levels of stress related to high-stakes testing, sleep deprivation, and demanding schedules. This places students at particularly high risk for the ill-effects of elevated stress, including depression, substance abuse, and overall deterioration of mental health. The benefits of physical exercise on stress levels are well documented. We hypothesize that participation in physically active games combined with positive interactions with young students will reduce self-reported stress in medical students. Program Description/Teaching Point: An ongoing program at a U.S. medical school is described, consisting of weekly 2-h sessions led by medical students at a local elementary school. Sessions include 1 h of physical activity including outdoor games. Following exercise, a second hour consists of preplanned lessons covering general wellness topics taught by medical students. This student-led program has been ongoing for 5 years throughout the spring and fall semesters. To date, the efficacy of these sessions in reducing stress among students has not been studied. A simple web-based self-reporting tool has been designed for use during the upcoming program. Participants will report relative stress on a 10-point Likert-type scale prior to beginning the program as a baseline, before and after each session, and following the completion of the year-long program. Stress levels will then be reassessed among participants during the following school year. We hypothesize that self-reported stress among students will decrease following session participation, and that relative stress levels will remain lower relative to baseline over time. Conclusion: A program of weekly sessions led by medical students at a local elementary school combining physical activity and wellness lessons has been implemented. The second year medical student leaders of this program have designed this study and aim to measure self-reported stress among medical students before and after participation in these sessions. (3653) Disclosure Patterns of Concomitant Use of Conventional and Complementary Medicine to Health-care Providers Within the General Population and Among Individuals With Chronic Health Conditions Amie Steel, PhD, ND1, Hope M Foley, BHSc (Nat) (Hons)2 and Jon Adams, PhD3 1Endeavour College of Natural Health, University of Technology Sydney, Brisbane, Australia 2Endeavour College of Natural Health, University of Technology Sydney, Sydney, Australia 3University of Technology Sydney, Sydney, Australia Abstract Purpose: Concomitant use of conventional and complementary medicine (CM) is common. There are risks associated with unmanaged concomitant use and potential benefits when such use is appropriately managed. This is particularly true for individuals with chronic conditions who more commonly engage in concomitant use. However, individuals utilising both conventional and CM do not always disclose concomitant use to health-care practitioners, increasing potential for adverse outcomes and hindering access to potential benefits. This study assesses rates of disclosure of CM to conventional practitioners, and of conventional medicine to CM practitioners within the Australian general population, alongside comparison of disclosure rates between individuals with and without diagnosed chronic conditions. Results: Full sample comprised 2019 respondents. Rates of full disclosure of CM use to conventional practitioners were reported as 71.5% to specialist doctors, 68.6% to GPs, 61.2% to hospital doctors, and 50.5% to pharmacists. Individuals with chronic conditions were significantly more likely to disclose CM use to conventional practitioners (P = .004 GPs, P = .004 hospital doctors, P = .005 pharmacists, P = .024 specialist doctors). Rates of full disclosure of conventional medicine to CM practitioners were substantially lower (41.9% to chiropractors, 38.5% to massage therapists and naturopaths, 35.6% to acupuncturists, 32.2% to traditional Chinese medicine practitioners, 28.9% to homeopaths). Conclusions: Disclosure rates of CM use to conventional providers in Australia have substantially improved over the last decade. However, CM practitioners are encouraged to initiate discussion with patients about conventional medicine use to reduce risks and optimise benefits of concomitant use. (3659) Medicinal Cannabis and Cancer: A Narrative Systematic Literature Review Danielle Brown1, Janet Schloss, PhD1 and Amie Steel, PhD, ND2 1Endeavour College of Natural Health, Brisbane, Australia 2Endeavour College of Natural Healthm, University of Technology Sydney, Brisbane, Australia Abstract Purpose: Medicinal cannabis (Cannabis sativa) and its use by cancer patients has been brought to the forefront in many countries due to new legislation. The potential benefits of medicinal cannabis for cancer symptom relief have been subject to a number of government reviews in addition to public debate in recent years. Currently, there is evidence for medicinal cannabis use for individuals with cancer in the managment of nausea and vomiting, as adjunctive analgesic for severe pain, and as an appetite stimulant. However, to date there is no systematic literature reveiw which comprehensively examines the current research regarding medicinal cannabis in all cancers and cancer-related symptoms. Results: The results found that medicinal cannabis shows promise in assisting patients with cancer for various symtomology, in addition to having potential anticancer activity. Trials have confirmed benefits for nausea and vomiting, pain and appetite stimulation, potential anticancer actions (in vitro and in vivo), reduction of seizure activity, and sleep assistance. Conclusions: This review indicates that further clinical trials are required to ascertain the benefits of medicinal cannabis as well as the dosage, ratio of cannabinoids for different symptoms or cancers, timing, potential interactions and targeted populations most appropriate for this herbal medicine. (3664) Initial Experience With Tai Chi and Meditation With Long-term Inpatients in a Psychiatric Facility Maya Armstrong, oh Abstract Overview: This presentation will summarize the experience and highlight successes from a 12-session pilot program using meditation and a short-form of tai chi in stable, long-term inpatients on a forensics unit in a psychiatric facility. Patients: History of arrest (alleged crimes typically violent in nature) committed to the facility as part of a competency restoration program, which may last months to years. Diagnoses include schizophrenia, bipolar disorder, and various personality disorders. Patients are relatively stable on medical therapy. Program: The program, which is voluntary and in addition to their regular daily activities and therapies, consists of weekly 1-h sessions, consisting of approximately 30 to 35 min of tai chi, 10 to 20 min of guided meditation, and 10 to 15 min of written reflection and/or discussion, all of which are grounded with words and movements that reinforce healing intentions, mindfulness, and self-care. Rationale: This project embodies the theme of “Collaboration in Action.” First, the setting—inpatient care and rehabilitation of individuals with chronic mental health issues—requires a collaborative, team-based approach, involving physicians, nurses, and a variety of mental health professionals, as well as the patients and their families. Second, this project combines clinical experience, potential for research, and implications for policy. Third, it highlights the collaborative nature of integrative therapies and their role in the recovery process for individuals with mental health problems. Objectives: The aim is to summarize the key components of tai chi and meditation and explain their utility in the inpatient management of complex mental health conditions; identify other settings in which similar approaches may provide benefit for physical and mental health; and access resources to aid in the development of clinical programs utilizing meditation and/or tai chi. (3666) Effectiveness and Safety of the New Percutaneous Release Technique Cutting Knife for the Stenosal Tendosynovitis: A Randomized, Participants-Blinded, Active Controlled Parallel Trial Changxin Liu1, Xiyou Wang1, Tao Luo1 and Changhe Yu, PhD1 1Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: The aim of this study is to evaluate the effectiveness and safety of the new percutaneous release technique cutting knife for the stenosal tendosynovitis. Results: A total of 120 participants were included and divided into each group with 60 patients, where there was not across the groups. All 119 participants completed the trial and analyzed for intentional analysis (ITT). The trigger Week 27 cure rate for patients in the intervention group was 91.70% (55/60), while the control group was 65.00% (39/59). There was significant difference between 2 groups (P < .001). After the treatment, the indices NRS, ROM, and sign of trigger digits of both groups were significantly improving with the time. The intervention group showed proved superior to the control group in the indices of NRS, ROM, and signs. No adverse events or complication happened in both groups. Conclusions: The cure rate of cutting knife treating stenosal tendosynovitis was high. Besides, cutting knife could also relieve the pain, release the joints’ range of motion, reduce the sign of trigger digits, and the effectiveness could last as least 27 weeks after only one treatment, without any safety problems. The trial offered evidence of the cutting knife for stenosal tendosynovitis. (3668) Factors Affecting Patients Participation in and Completion of Acupuncture Clinical Trials: A Cross-sectional Survey JianPing Liu, PhD1, Yajing Zhang1, Huijuan Cao, PhD1 and Xinlin Li1 1Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: To explore factors influence on patients participating in and completing acupuncture trials. Results: All participants with the age of 15–85 years completed the survey. When investigating patients’ attitude towards enrolling in a trial, the therapeutic effect and the safety of the intervention were thought (by 92% and 96% respondents, respectively) as important deciding factors. For surveyed participants, only 40 of them (8.0%) had involved in clinical trials before, the LRA showed they paid more attention to treatment regimen (frequency and session of treatment) when deciding whether joining in trials (OR 1.54, 95% CI 1.02 to 2.34). Multivariate LRA showed that elder people took cost (OR 1.36, 95% CI 1.09 to 1.70) as a more important factor; the participants used medical insurance (OR 1.45, 95% CI −0.20 to 0.93) preferred to think informal consent was important; meanwhile, participants with higher education level preferred to regular follow-up (OR 1.16, 95% CI 0.02 to 0.28). Conclusions: The effect, safety of the intervention and treatment regimen of a trial would be important factors for patients on deciding whether to join in or complete acupuncture studies. Other factors, such as cost or consent, should be given special consideration according to specific demographic characteristics. (3669) A Pilot Trial Examining the Absorption of Oral Forms of Folic Acid Supplementation in a Healthy Population Janet Schloss, PhD1, Jessica Bayes1 and Nitish Agrawal, PhD1 1Endeavour College of Natural Health, Brisbane, Australia Abstract Purpose: The purpose of this trial is to investigate the absorption of three different oral folate supplments in healthy individuals. The aim is to see if there is any difference between the different forms in absorption and utilisation. Considering folate supplements are frequently prescribed by health professionals, the oral asbsorption of the three main forms of folate is unknown, which is an important factor for clinical relevance. Results: A total of 31 participants were randomised with 1 participant excluded due to being found deficient in folate (5.3 ug/L). Of these, 4 participants were found to have both MTHFR mutations, 7 had A1298C mutation, 9 had C6777T, and 4 had no MTHFR mutations. The control group serum levels were consistent with little variation over the 4 weeks. Within the intervention groups, all saw an increase in absorption with variations noted both in form and in those participants with MTHFR mutations. Conclusions: Oral supplements of folate, folinic acid and 5-MTHF all show absorption over 4 weeks. For healthy individuals who have a MTHFR genetic mutation, absorption can vary depending on the folate form and their genetic mutation. Further studies are required, but this study showed that absportion varied depending on the folate form and if the person had a MTHFR mutation. Trial number: ACTRN12617001033336 Protocol number: 20170761 (3674) A Pilot Study of a Mindfulness Website for Teachers and Classrooms: DeStress Mondays Tamar Mendelson, PhD1, Lindsey Webb, MS, MHS1 and Erica Sibinga, MD1 1Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Abstract Purpose: Research has begun to highlight the positive effect of mindfulness instruction for teachers in need of resources to reduce stress. However, issues arise in the logistics of implementing mindfulness programming to primary school teachers, as they face the barriers of limited time and competing priorities. The aim of this study was to examine the feasibility and acceptability of a website designed to provide teachers with mindfulness practices that could be used for self-care, as well as in the classroom with students. Additionally, the study aimed to explore the potential impact of website practices on teachers' mental and physical well-being. Results: Across the three schools, 50 teachers participated in the baseline survey (82% female, 52% African American). A majority of the teachers who participated in the postprogram survey (n = 41), reported using the website practices at least 1–3 times during the study period for self-care (85.3%) or in the classroom (65.9%). Significant pre–post differences were seen in several variables, including a decrease in work-related stress (P = .001), perceived stress (P = .01), depression (P = .001), and anxiety (P = .02), as well as an increase in overall sleep quality (P = .001). Conclusions: Results from this pilot pre-post study provide preliminary evidence that the practices delivered by a mindfulness website may help improve the mental health and well-being of primary school teachers. Future research should focus on further evaluating web-based delivery methods for mindfulness interventions and practices to teachers using control groups, larger sample sizes, and longitudinal study designs. (3677) Prospective Safety Evaluation of a Dietary Supplement Commonly Recommended by Integrative Health-care Providers to Support Blood Pressure Levels Jennifer J Ryan, ND, MS1, Ryan Bradley, ND, MPH1, Janae Taylor, BA1 and Douglas A Hanes, PhD1 1National University of Natural Medicine, Portland, Oregon Abstract Purpose: The purpose of this study was to prospectively evaluate the safety of a popular herbal-mineral supplement that is commonly recommended by many integrative health-care providers to support healthy blood pressure levels. Although the study product has been on the market since 1993, no formal safety studies had previously been conducted on the finished product. Results: There were no serious adverse events. Of 30 participants who began the study, 19 completed the 6-month study visit, 9 dropped out citing potential side effects (most frequently nasal congestion or fatigue), 1 was withdrawn, and 1 was lost to follow up. Outcomes with at least a medium effect size (d > 0.5) included serum potassium, PHQ-9 score, systolic blood pressure, and diastolic blood pressure. A slight increase in potassium (within normal reference ranges) was significant (P < .05) and decreases in systolic and diastolic blood pressure were highly significant (P < .0001). Conclusions: These results suggest that the investigated blood pressure support supplement is safe in adults with blood pressure readings consistent with pre-hypertension and stage I hypertension. Aspects of this study may serve as a model for the long-term, rigorous monitoring of the clinical safety of dietary supplements used by integrative health-care practitioners. (3678) Complementary Medicine and Use of Contraception Amie Steel, PhD, ND1 1Endeavour College of Natural Health, University of Technology Sydney, Brisbane, Australia Abstract Purpose: The choice of naturopathy as a career is rarely a linear path for most members of the profession. Social norms do not lend individuals who are interested in a career in health to move beyond the common professions such as nursing, medicine, and pharmacy to consider complementary medicine (CM) professions. The biography of those who decide on CM for their chosen field is commonly more circuitous. The purpose of this study is to describe the experiences and perceptions of individuals who have chosen naturopathy as a career with regards to their journey to this decision. Results: Two dominant typologies were identified: The Accidental Tourist and the Wounded Healer. The Accidental Tourist individual was not aware of naturopathy as a career option until an unexpected encounter brought it to their attention. The Wounded Healer described choosing naturopathy as a career based on seeing the benefits of naturopathy in the management of illness, primarily their own. Philosophical and ideological drivers found to underpin the choice of naturopathy as a career included the alignment of naturopathic principles with the individual’s personal philosophy and dissatisfaction with conventional health care. Conclusions: In line with the ever-increasing professionalization of naturopathy in the international landscape, this study presents novel findings about the characteristics of naturopathy as a career as perceived by individuals within the profession. These findings may help in for policy and education practices in an underresearched health profession. (3680) Cohort Study of Evaluating the Outcomes of Insomnia Treated by TCM Patterns Differentiation Among Different TCM Physicians Changhe Yu, PhD1, Ya’nan Sun, PhD2, Liyun He, PhD3 and Baoyan Liu3 1Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China 2Xuanwu Hospital Capital Medical University, Beijing, China 3China Academy of Chinese Medical Sciences, Beijing, China Abstract Purpose: Take insomnia as an example, to evaluate the effect of physicians’ treatment for insomnia by TCM patterns differentiation and to analyze the difference and the characteristics of TCM physicians’ treatment. Based on the results of former 2, the methodology was explored and established to evaluate the effect of treatment by the TCM patterns differentiation with the application of physicians’ cohort study. Results: The outcome effective rates of TST and PSQI from high to low ranks were TCM Physician C, D, B, and A. That meant the insomnia-related symptoms were the main factors influencing the effective rates. Results of data mining took TCM Physician A as an example that 3 core prescriptions were analyzed based on those that the TCM physician offered. TCM patterns, individualized treatment and changes of outcomes were obtained. Besides, the qualitative comparisons were conduct between the results of data mining and those the TCM physician offered. The correlation of TCM patterns, individualized treatment and changes of outcomes from TCM Physician A was stronger than those from either 2 TCM physicians, which proved that the TCM Physician A showed high self-consistence in the relationship of TCM patterns, individualized treatment and changes of outcomes, but there were large differences between either two TCM physicians. The results proved the research hypothesis that TCM patterns differentiation took TCM physicians as the core part, and was an individualized diagnosis and treatment process of high correlation of TCM patterns, individualized treatment and changes of outcomes. All above results could prove that the methodology of cohort study design, complement, data mining, and analyses was scientific and feasible. Conclusions: TCM physicians as the core of the cohort study method can evaluate the effect of different physicians’ treatment based on their TCM patterns differentiation. Based on the effectiveness of the TCM physicians’ treatment, the regularity and characteristics of their treatment by TCM patterns differentiation were analyzed. This method was scientific and feasible to the research hypothesis that TCM patterns differentiation took TCM physicians as the core part and was an individualized diagnosis and treatment process of high correlation of TCM patterns, individualized treatment and changes of outcomes. (3681) Expert Consensus on the Comprehensive Individualized Protocol of Tuina Therapy for Knee Osteoarthritis Lunxue Qing1, Changxin Liu2, Xiyou Wang2 and Changhe Yu, PhD1 1Beijing University of Chinese Medicine, Beijing, China 2Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: The expert consensus was researched on the comprehensive individualized protocol of Tuina therapy for Knee osteoarthritis for future RCT study. Results: Based on the literature review and the interviews, the preliminary Tuina protocol contained 3 specific Tuina treatment, whose process showed 8, 5, and 9 manual practice, respectively. After discussions in the expert consensus, 3 sets of specific protocols were researched on the Chinese Tuina therapy for KOA, which indicated the individual classification based on the KOA main symptoms. In the protocol, 75%–80% of the entries were considered as strong recommendation and the others were weakly recommended. Conclusions: According to the expert consensus, the comprehensive individualized protocols of Tuina therapy for KOA are feasible and reproducible. Thus, it is suitable for RCT as an intervention after standardization. (3686) A Prospective, Observational Study of Complementary and Integrative Health Approaches to Improve Pain and Functioning in Veterans: The VA PRIMIER Study Stephanie L Taylor, PhD, MPH1, A Rani Elwy, PhD2, Dorothy N Plumb, MA2, Shibei Zhao, MPH2, Michael G McGowan, MA2, Nui G Brown, MA3, Wendy Westleigh, BA4, Grace W Yan, PhD5 and Barbara G Bokhour, PhD5 1VA Greater Los Angeles Healthcare System, Los Angeles, California 2Los Angeles, California 3Greater Los Angeles VA Medical Center, Los Angeles, California 4VA New Jersey Healthcare System, East Orange, New Jersey 5Bedford, Massachusetts Abstract Purpose: Our objective was to replicate the BraveNet practice-based research network’s Patients Receiving Integrative Medicine Interventions Effectiveness Registry (PRIMIER) patient reported outcomes (PROs) study among Veterans receiving complementary and integrative health (CIH) approaches at Veterans Affairs (VA) medical centers. Results: Veterans (n = 288) participated in 23 forms of CIH approaches and completed surveys at two VA sites between 2015 and 2017. Those who participated in tai chi (estimate = 1.62, P < .01) and guided imagery (estimate = 4.33, P < .01) reported less average pain and those who participated in tai chi reported less current pain (estimate = 1.69, P < .001) than Veterans who participated in other CIH approaches over the 12-month period. Yoga participants reported less stress at 12 months compared to their baseline reports (estimate = 2.12, P < .01), while those who used acupuncture reported reductions in stress at 2 months versus baseline scores (estimate = 11.08, P = .02). Tai chi participants reported greatest improvements in functioning (estimate = 8.34, P < .01). There were no significant results of CIH approaches on patients’ activation for self-management of their health. Conclusions: In this first longitudinal examination of CIH approaches on Veterans’ current and average pain, perceived stress and physical and mental health functioning, tai chi, guided imagery, yoga, and acupuncture appear to have the greatest impact on Veterans’ patient reported outcomes over time. (3688) Analyzing on Mechanisms and Medication Rules of Herbal Prescriptions for Children With Indigestion Due to Accumulated Heat in Stomach Based on Methods of Bioinformatics Yuxiang Wan, MD1, Li Yi Nyiam, MD1, Xia Zhang, MD1, Chen Bai, MD1, Yunhui Wang, MD1, Tiegang Liu, PhD1, He Yu, PhD1, Xiaohong Gu, MD1 and Zian Zheng, PhD1 1Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: To explore the medication rules and mechanisms in herbal prescriptions for indigestion due to accumulated heat by the methods of data mining and network pharmacology. Results: Among the 150 screening prescriptions, we obtained 6 core drug combinations and 3 new prescriptions, 9 high-frequency herbs groups of similar properties, flavor and meridian tropism and 330 related targets. In the network comprised with those action targets, there were 2961 actions and 137 signaling pathways (FDR < 0.01). Among those signaling pathways, there were 7 pathways had the most closely relationship with the digestive system. Conclusions: For children with indigestion due to accumulated heat in stomach, the commonly used therapy of TCM was ridding of retained food, regulating qi and tonifying the spleen, and clearing heat and dampness. And its action was achieved by the regulation of digestive juice secretion, regulation of intestinal digestion and immunity, the body’s immune function of microorganisms and other multitarget complex pathway. (3690) Changes in Prescription Rates of Antimicrobials in Respiratory Departments Between Western Medicine Hospitals and Integrative/Traditional Chinese Medicine Hospitals Under the Stewardship Ruixue Hu1, Xiaoying Yang1, Lingzi Wen1, Sainan Fang1, Nanqi Zhao1, Na Huang1, Xinlin Li1, Yu-tong Fei, MD, PhD1, Di Wang1, Yajing Zhang1 and Baoyong Lai2 1Beijing University of Chinese Medicine, Beijing, China 2Center for Evidence-based Chinese Medicine, Beijing, China Abstract Purpose: Our study aims to explore the changes of prescription rates of antimicrobials in respiratory departments between western medicine (WM) hospitals and integrative/traditional Chinese medicine (IM-TCM) hospitals. Results: Two hundred fifty-eight reports were included: 238 reports were from WM hospitals and 20 from IM-TCM hospitals. Data covered 24 provinces and 3 municipalities in China. In east China, antimicrobial prescription rates of IM-TCM hospitals dropped greatly during and after the stewardship, from 90% (2 studies, 238 patients, I2 = 73%), 63% (3 studies, 1208 patients, I2 = 94%, random) to 39% (2 studies, 1160 patients, I2 = 95%) comparing to those of the WM hospitals, from 89% (51 studies, 15 296 patients, I2 = 98%), 77% (22 studies, 8723 patients, I2 = 98%) to 76% (8 studies, 5751 patients, I2 = 97%). In tertiary hospitals, the antimicrobial prescription rates in IM-TCM hospitals responded to the stewardship better, from 93% (5 studies, 631 patients, I2 = 82%), 81% (5 studies, 1578 patients, I2 = 97%) to 31% (1 studies,1100 patients, I2 = 94%), comparing to WM hospitals, from 90% (91 studies, 28 407 patients, I2 = 95%), 89% (26 studies, 14 775 patients, I2 = 98%) to 79% (10 studies, 7559 patients, I2 = 95%). Data of IM-TCM hospitals from other parts of China and other level of hospitals were insufficient to analyze. Conclusions: Respiratory departments in east China and in tertiary hospitals (both IM-TCM hospitals and WM hospitals) responded to the policy effectively. Use of TCM might reduce the noncompulsory use of antimicrobials for patients. More data for use of antimicrobials for outpatients from secondary, primary, and private practices and from IM-TCM health-care organizations are needed. (3693) Adverse Events and Adverse Drug Reactions of a Patent Chinese Herbal Medicine: Inconsistency of Data From Literatures and Real-World State Monitoring Jianping Liu, PhD1, Di Wang1, Xun Li, PhD1, Ruyu Xia1, Yutong Fei, PhD1, Ruixue Hu1 and Liqiong Wang, PhD1 1Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: To investigate the consistency of Adverse Events/Adverse Drug Reactions (AEs/ADRs) from the real-world state monitoring data, the whole literature base, RCTs and non-RCTs in a patent Chinese herbal medicine (PCHM). To explore the PCHM’s risk of biased scope of using the RCTs data rather than monitoring data or the whole literature base in Systematic Reviews (SR) of interventions to draw safety conclusions. Results: Proportions of the most prevalent AE in CFDA monitoring data, whole literature, RCT reports, and case series/case reports were consistent. Proportions of the most prevalent ADRs were different in RCT reports comparing with other information sources. Distributions of both symptoms and affected system-organ disorder classes of AEs and ADRs were different between CFDA monitoring data and literatures, with those from RCT reports varied most from others. Data from CFDA were with better quality and relatively comprehensive. Case series and case reports contributed important data. ADRs looked insufficiently inference and reported in RCTs. Conclusions: This PCHM distribution of AEs and ADRs from RCTs is the least likely similar with the data from the monitoring system, which is largely consistent in the most prevalent AEs/ADRs with the data from the whole literature base or non-RCTs. For intervention systematic reviews that included only RCTs, conclusions for safety should be drawn with special cautious. (3698) Investigation on the Effects of Acupuncture on Cognitive Improvement Using f-NIRS Ho-Ryong Yoo1, Hyuntae Kim2, Eunsun Jung2, Jeongeun Yoo, KMD, PhD2 and Jeonghyo Cho, KMD, PhD2 1Daejeon, South Korea 2Daejeon University, Daejeon, Republic of Korea Abstract Purpose: Neuroimaging studies have been actively conducted to find out neural mechanism of acupuncture therapy to influence the cognitive function. Nonetheless, the effects or mechanism of acupuncture therapy have not been proven on cognitive function. Therefore, this study aimed to seek the feasibility and therapeutic mechanism of acupuncture therapy on the improvement of cognitive function in normal subjects upon checking the changes of hemodynamic response in prefrontal cortex in the process of working memory (WM) task before and after the acupuncture treatment using functional near-infrared spectroscopy. This is a preliminary study to confirm whether acupuncture treatment is effective for patient with mild cognitive impairment. Results: It was observed that for almost subjects, the frontal region seems to get more active after acupuncture. A reason may be that the subject’s feel more comfortable/relaxed after stimulation and they have to pay more attention to the working memory task after acupuncture. An increased focus cause an increase in ΔHbO in the frontal regions, this increase is significant in comparison to ΔHbO changes before acupuncture. The results showed significant changes before and after acupuncture in ΔHbO. And type-A group’s ΔHbO changes were significantly better than those of B and control group’s measure. Also, the working memory tasks scores for both Group A and B after acupuncture were better in comparison to the scores achieved by the control group. Conclusions: As the subject’s scores were better after acupuncture, this indicates that acupuncture is effective in improving brain activity and cognitive function. (3705) Evaluating the Impact of Telephone and Text Message Reminders on Patient Return to Acupuncture Follow-up Treatment: A Randomized Controlled Trial Chih-Ping Chou, PhD1, Chun Nok Lam, MPH1, David S Black, PhD1 and Chris Ruth, LAc, DAOM2 1Los Angeles, California 2Emperor’s College of Traditional Oriental Medicine, Santa Monica, California Abstract Purpose: This study tested the relative impact of two reminder delivery methods using telephone call and text messages to increase patient return rates to acupuncture follow-up treatment. Results: One hundred twenty participants (age: M = 42 ± 13 years, 28% male) were enrolled in the study. Two thirds (63%) received a treatment plan recommending follow-up visits. Chart review showed that 68 participants (57%) returned for at least 1 follow-up visits. Return rates were 58% for the call group, 58% for the text group, and 55% for the control group. Proportional differences between trial conditions did not reach statistical significance (χ2 = 0.07, P = .97). Logistic regression analysis showed that having a treatment plan (OR = 2.9, 95% CI = 1.2, 7.2, P = .02) and intention to follow-up (OR = 2.6, 95% CI = 1.3, 5.2, P < .01) predicted patient return. Odds of patient return was lower among participants who experienced immediate symptom improvement (OR = 0.4, 95% CI = 0.2, 1.0, P = .04). Greater expectancy of acupuncture was associated with intention to follow-up (beta = 0.1, 95% CI = 0.0, 0.2, P < .01). Conclusions: A 1-time telephone call or text message reminder did not increase patient return rates to acupuncture follow-up treatment. Future intervention can focus on improving intention to follow-up and expectancy of acupuncture. (3709) Real-time Relief of Video-induced Stress by Acupressure Stimulation of Relaxation Points Used for Symptom Cluster Xiaoshi Zhang, BS1, Jacqueline Nguyen, BS1, Shin Lin, PhD1 and Jackson K Tran, BS1 1Irvine, California Abstract Purpose: Acupressure on 5 “relaxation points” has previously been shown to relieve a cluster of symptoms: sleep disorder, pain, depression, and fatigue. This study tests whether such a treatment can relieve stress induced by horror movies in real time. Results: Viewing of horror movies induced stress measured as increases in heart rate from a baseline of 64.4 ± 3.6 beats/minute (mean ± SEM) to 103.7 ± 13.4 and LF/HF from 0.8 ± 0.3 to 2.2 ± 0.7. Acupressure on Anmian reversed these changes substantially to 83.6 ± 12.0 and 1.2 ± 0.3. Changing to acupressure on sham point (subject blinded) partially reduced these changes to 99.3 ± 16.2 and 1.9 ± 0.2. When acupressure was on sham point followed by Anmien, the results were essentially reversed: heart rate 60.1 ± 1.7 to 108.5 ± 1.7 to 112.5 ± 1.6 to 93.3 ± 4.1, and LF/HF 0.9 ± 0.3 to 1.4 ± 0.1 to 1.8 ± 0.4 to 0.9 ± 0.0. All of the above trends in heart rate and HRV changes were observed in experiments on the other relaxation points SP6, LV3, HT7, and Yin Tang. Conclusions: The results of this study show that acupressure on all 5 “relaxation points” substantially reversed increases in heart rate and sympathetic tone induced by watching horror movies in real time. Such stress relief is likely an important basis of the reported efficacy for acupressure treatment of the symptom cluster. (3710) Addressing Concussion Symptoms With Massage and Manual Therapy Principles Sylvia Burns, MEd1 1Newberg, Oregon Abstract Overview: Concussion, its recognition, diagnosis, and treatment, is a growing public health issue in the United States. Practitioners were specialized in rehabilitation deal with a variety of injury cases that involve concussions. This includes those incurred by falls, motor vehicle incidents, and sports injuries. This session presents a unique approach using biomechanical principles as used by massage and manual therapy to diminish concussion symptoms and regain ease of range of motion in the cervical area. Rationale: The treatment of concussion is important for the recovery of function and health of the brain following a brain injury. The triage of physical and mental conditions of the injury, evaluations of balance and cognition, and assessment of fracture or hemorrhage is appropriate for the medically trained physician. Following the initial event imaging and medical work, the patient has the challenge of rehabilitation. By implementing the massage and manual therapy principles to the case, the course of treatment may be abbreviated and the use of pharmaceuticals minimized. This pattern of treatment encourages the interface of all types of recovery treatment of the patient. Objectives: Objectives of the presentation is to understand the anatomy/kinetics of the atlanto-occipital joint, to recognize the resulting movement of the joint from trauma, to create an analysis of the trauma and how the biomechanics of it affected this site, and to apply the principles of balancing the body/posture for the rehabilitation. (3711) Wellness Curriculum for Psychiatric Residents A Ning Zhou, MD1, Wendy Feng, MD1, Andrea Rosati, MD1, Erick Hung, MD1 and Stefana Morgan, MD1 1San Francisco, California Abstract Background: Psychiatry residents experience many stressors including high-pressure environments, busy schedules, financial difficulties, and vicarious trauma. There is growing evidence for the efficacy of integrative approaches for improving well-being as well as for prevention and treatment of mental health issues. Over the past 3 years, the University of California, San Francisco (UCSF) Department of Psychiatry has designed, piloted, and refined a resident-led Wellness Curriculum that introduces residents to evidence-based integrative approaches they can apply to patient care and allows residents to incorporate integrative practices in their busy lives. Program Description: The curriculum aims to familiarize residents with integrative healing approaches and resources; engage residents through interactive, hands-on experiential exercises which allow residents to practice integrative approaches which promote well-being; and educate residents regarding guidelines for communication and collaboration with non-traditional practitioners. The curriculum included 3–8 sessions annually and was designed and led by UCSF psychiatry residents with support from the training program. Needs assessment was accomplished at the start of every year to guide the scope of the curriculum and respond to naturally shifting resident interests. The curriculum began as an elective course and due to resident feedback was eventually incorporated into the formal residency training curriculum. Each session focused on 1 type of integrative approach which included massage, mindfulness, yoga, tai chi, dance, music, contemplative hikes, and so forth. Session length was about 1.5 h and started at 8 am. The sessions included a 60-min experiential component and 30-min didactic component which presented the evidence base for the integrative approach. In order to ensure attendance, breakfast was provided and residents were given time off from clinical duties. Conclusion: The course was well received by residents. This curriculum could be utilized as a model by other residency training programs to support resident well-being and advance knowledge about integrative psychiatry approaches. Rationale: The topic of wellness and integrative approaches to health is an emerging area of interest in psychiatry training programs. Psychiatry residents who are educated in integrative approaches to wellness may be able to better understand and utilize for themselves and for patients. Their familiarity with these topics may help them work collaboratively with practitioners of integrative, complementary, and alternative modalities. Objectives: The participants in this presentation should be able to identify the needs of psychiatry residents with respect to bolstering their well-being and resilience through integrative approaches; describe the didactic and hands-on components of the integrative approaches used in the Wellness Curriculum at UCSF; and describe the effectiveness of the UCSF Wellness Curriculum for psychiatry residents. (3713) Analysis of Randomized Trials of Traditional Chinese Medicine for Cancer From the Registry of Cochrane Complementary and Alternative Medicine Field Chunli Lu1, Xuehan Liu1, Yuqian Yan1 and Jianping Liu, PhD1 1Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: To provide evidence-based references for scientific research and clinical applications in treating cancer by traditional Chinese medicine (TCM). Results: The proportion of randomized trials in ProCite database was 43.88% (8742/19 921), cancer and cancer-related conditions accounting for 7.09% (620/8742) of the ratio, which ranked second of all the diseases by frequency. The proportion of randomized trials with better efficiency in the combined treatment of TCM therapies than Western medicine therapies was 99.57% (466/468). The proportion of randomized trials with better efficiency in TCM therapies than Western medicine therapies was 99.19% (122/123). The proportion of randomized trials with better efficiency in TCM therapies than blank or placebo was 100% (15/15). The remaining 14 trials were about comparison of different TCM therapies. Conclusions: This study confirmed that TCM therapies have promising effect on reducing the toxicity, prevention of tumor metastasis and recurrence, prolong survival, and improvement of quality of life, etc. However, giving reflection on the results, there might have a risk of publication bias. It is very necessary to pay more attention on the transparency of future clinical trial from protocol registration to complete reporting of all available data, thus to avoid incomplete data reporting and selective outcome reporting. We also suggest to provide the most promising treatment as intervention for target types of malignant tumor or related conditions. (3714) Effects of Milk Thistle Extract (Silibinin) on Circulating Unconjugated Bilirubin Levels and Markers for Oxidative Michael J Watson, PhD1, Andrew Bulmer, PhD2 and Josif Vidimce, BSc2 1Endeavour College Natural Medicine, Gold Coast, Australia 2Griffith University, Gold Coast, Australia Abstract Purpose: Extracts from Milk Thistle (Sylibum marianum) have been used as medical remedies for around 2000 years. They continue to be used as therapeutic agents in herbal medicine for the treatment of acute and chronic liver diseases. Its effects have been shown to due to an antioxidant and anti-inflammatory effect and have been directly attributed to the silibinin molecule. In addition to this and consistent with an effect on the hepatic biliary system is evidence from a number of in vitro studies which demonstrate that an active constituent within Milk Thistle extract called Silibinin acts as a partial UDP-glucuronosyltransferase 1A1 (UGT1A1) inhibitor. UGT1A1 is involved in the conjugation of endogenous compounds such as bilirubin, steroids and bile acids. Specifically, the conjugation of glucuronic acid to these substrates increases their polarity and hence solubility so as to facilitate their excretion from the body. Preventing bilirubin glucuronidation through the inhibition of UGT1A1 would lead to a mild increase in the circulating unconjugated bilirubin termed ‘mild hyperbilirubinemia’ and is of no clinical concern. The effect of partial inhibition of UGT1A1 function is observed in individuals with Gilbert’s syndrome, which is a harmless condition and affects 5–10% of the general population. Individuals with Gilbert’s syndrome present with mild hyperbilirubinemia caused by a genotypic variation in UGT1A gene, reducing UGT1A1 activity by approximately 65%. Many clinical studies and clearly demonstrate a dramatic reduction in the incidence of cardiovascular disease and atherosclerosis in patients with Gilberts syndrome and attribute this protection to elevated bilirubin concentrations. Indeed, cardiovascular (CVD) risk reduction increases with increasing bilirubin concentrations, in otherwise healthy individuals. A number of clinical studies also associate mildly elevated bilirubin with a reduction in key inflammatory markers for CVD, improvements in endothelial function, blood lipid profile and reductions in platelet reactivity. Additional approaches to increasing bilirubin include prescription of the anti-viral medication, Atazanivir, which is also an inhibitor of UGT1A1. Patients treated with Atazanivir for HIV infection show an increase in circulating bilirubin levels, which are strongly correlated with a reduction in markers for oxidative stress. Furthermore, administration of Atazanivir to diabetic patients without HIV improves antioxidant capacity and vascular function. These studies provide additional evidence that increased bilirubin, induced by UGT1A1 inhibition (identical to the mechanism of silibinin), increases antioxidant capacity and reduces CVD risk. Atazanivir has a number of serious side effects related to its anti-viral properties and would be inappropriate to use in the current study. Therefore, alternative natural UGT1A1 inhibitors with a documented safety profile, including silibinin, represent excellent candidates for further investigation. The aim of this pilot study will be to examine the effect of a short-term (21 days) administration of the Milk Thistle extract, Legalon® on markers for inflammation, endothelial function, blood lipid profile and platelet reactivity in healthy volunteers. (3715) Chuna (or Tuina) Manual Therapy for Musculoskeletal Disorders: A Systematic Review and Meta-analysis of Randomized Controlled Trials Nam-Woo Lee1, Eui-Hyoung Hwang, KMD, PhD1, In-Hwa Park1, Gee-Heon Kim1, In Heo1, Koh-Woon Kim, KMD, PhD2, In-Hyuk Ha, KMD, PhD3, Jun-Hwan Lee, KMD, PhD4 and Byung-Cheul Shin, MD (DKM), PhD1 1Pusan National University, Yangsan, Republic of Korea 2Kyung Hee University, Seoul, Republic of Korea 3Jaseng Medical Foundation, Seoul, Republic of Korea 4Korea Institute of Oriental Medicine, Daejeon, Republic of Korea Abstract Purpose: To review the literature and systematically evaluate the effectiveness of Chuna (or Tuina) manual therapy (C[T]MT) on pain and function for musculoskeletal disorders. Results: Sixty-six randomized controlled trials (RCTs) with 6170 participants were included. One sham-controlled RCT showed that C(T)MT relieved pain more effectively than a sham control (SMD: −3.09 [−3.59, −2.59]). For active-controlled RCTs, pooled meta-analysis showed that C(T)MT had statistically significant effects on pain reduction, especially compared to traction (P < .00001), drugs (P = .04) and physical therapies (P < .0001). For functional improvement, combined effects of C(T)MT with drugs (P = .04) and traction (P = .05) also showed similar positive effects. Conclusions: This systematic review suggests that C(T)MT is safe and effective for pain reduction and functional improvement for musculoskeletal diseases; however, the evidence for functional improvement was not as strong as for pain reduction. For future studies, high-quality RCTs such as sham-controlled studies with standardized interventions are needed to provide sufficient evidence on the effects of C(T)MT for musculoskeletal diseases. (3716) Patient’s Perception for Developing Research Questions of a Clinical Practice Guideline of Korean Medicine for Degenerative Lumbar Spinal Stenosis: A Descriptive Cross-sectional Survey Ji M Bae, KMD1, Kun H Kim, KMD1, Gi Y Yang, KMD1, Byung R Lee, KMD1 and Ji W Choi, KMD1 1Pusan National University Korean Medicine Hospital, Yangsan-si, Republic of Korea Abstract Purpose: The purpose of this study is to explore patient’s view of developing research questions of a clinical practice guideline of Korean medicine for degenerative lumbar spinal stenosis. Results: Twenty of 40 invited participants responded to the questionnaire. Acupuncture, herbal medicine and cupping were the most frequently used Korean medicine interventions. Fourteen patients (70%) had experienced drug therapy (Table 1). Eighteen respondents reported that Korean medicine treatments were helpful for their improvement, while 6 of 19 stated that Western medicine treatments were beneficial. Among 16 patients who mentioned that research on Korean medicine is needed, the prioritized research topics were on acupuncture (88%), herbal medicine (45%) and bee venom acupuncture (38%) (Table 1). Important outcomes in the view of 19 respondents included functional recovery (65%), pain relief (50%), cost-effectiveness (20%), quality of life (15%), safety (10%) and overall prognosis (5%). Thirteen respondents (65%) replied that both short-term and long-term outcomes were important for them. Conclusions: Patients’ perceptions with regard to the important interventions and outcomes for the study of Korean medicine were explored. Findings are not representative due to the potential selection and information bias. Further study to reflect patients’ view on the development of the clinical practice guidelines of Korean medicine is needed. (3719) No One Is Ever Too Old or Weak to Set a New Exercise Goal Jason S Chen, BS1 and Sarah Ingersoll, MS, MBA1 1Los Angeles, California Abstract Overview: Background: The 5K Training Team, primarily for individuals with Parkinson disease, was inspired by the patients in a traditional support group who knew about the benefits of exercise. But they had excuses, the usual excuses, and did not exercise much. Program description: When the team started 2010, it was modeled on community teams for the able-bodied. A professional coach led off each training session with tai-chi-based “looseners,” followed by a walk/jog and then a light lunch. The goal for each season is participation in a community 5K. This routine has been modified only slightly over the intervening years. The conceptual framework has evolved to explicitly include social engineering concepts, particularly the approach articulated by the Behavioral Insights Team, a UK social purpose consulting company that applies behavioral science to policy. The assumption is that decisions, such as the decision to exercise, are primarily influenced by environment and habit. To encourage a behavior, make it Easy, Attractive, Social, and Timely (EAST). Teaching point: Older and frailer individuals will enthusiastically participate in a relatively rigorous exercise program that features “nudges” and appropriate incentives. The 5K Training Team, currently in its eighth season, is now supported in part by the Parkinson’s Foundation and participates in MovingDay as Team MovaDopa. “No one is ever too old or weak to set a new exercise goal.” Conclusion: The EAST approach focuses on drivers of behavior that health systems often neglect. This approach may serve as a model for diverse programs that promote health and wellbeing. Rationale: Healthy lifestyle is wonderful in theory but can be hard to achieve in practice. Social engineering principles can inform the development of successful efforts to encourage healthy behaviors. And healthy behaviors are a natural fit for “Collaboration in Action.” Objectives: The objective is to articulate the components and conceptual framework of an exercise program that appeals to older adults with neurologic and other challenges and that has sustained long-term participation. A secondary objective is to encourage the application of similar techniques to other wellness-related programs thereby championing the concept of wellness as well as improving the health status of our patients. Artwork citation: Roz Chast, The New Yorker, Conde Nast. (3723) Patent of Ophiocordyceps Sinensis (Jin Shui Bao) for Diabetic Kidney Disease: A Systematic Review and Meta-analysis Lingzi Wen1, Xia Tian1, Di Wang1, Ruyu Xia1, Yutong Fei, PhD1, Na Huang1, Ruixue Hu1 and JianPing Liu, PhD1 1Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: Diabetic kidney disease (DKD) is one of the major chronic complications of diabetes. Ophiocordyceps sinensis is a traditional Chinese herbal medicine, with immune regulation, anti-bacterial, anti-tumor, anti-oxidation, anti-aging, lower blood sugar and blood lipids, and other extensive pharmacological effects. Jin Shui Bao (JSB) capsule (about 20 million USD marketing per year) is a patent medicine for ophiocordyceps sinensis. We aim to systematically evaluate the effectiveness and safety of JSB capsule in the treatment of DKD. Results: Literature search revealed 20 articles including 1344 participants. All included trials were with high risk of bias, specially blinding. The inclusion of 20 articles did not directly report mortality, progress in nephropathy, the quality of life, eGFR, and CrCl. JSB combined with routine treatment compared to routine treatment, UAER (T: 659.7 ± 229.2; n = 30; C: 1159.7 ± 534.7; n = 30; MD: −500.00; 95% CI: −708.17, −291.83) and (T: 56.88 ± 44.63; n = 28; C:117.25 ± 36.75; n = 28; MD: −60.37; 95% CI: −81.78, −38.96), 24 h UP (MD: −329.30; 95% CI: −414.72, −243.88; I2 = 0%), SCr (MD: −22.95; 95% CI: −29.28, −16.62; I2 = 18%), number of ineffective treatment (RR: 0.35; 95% CI: 0.26, 0.48; I2 = 0%). JSB combined with routine treatment compared to routine treatment combined with placebo, 24 h UP (T: 610.0 ± 370.0; n = 36; C: 1210.0 ± 1090.0; n = 32; MD: −600.00; 95% CI: −996.53, −203.47), SCr (MD: −15.72; 95% CI: −33.49, 2.04; I2=56%), number of ineffective treatment (RR: 0.03; 95% CI: 0.00, 0.21). Adverse events were reported insufficiently. All evidence was assessed as low certainty by GRADE approach. Conclusions: JSB combined with routine treatment can lower UAER and 24 h UP and improve the efficiency of clinical treatment compared to routine treatment or placebo. However, the quality of the existing evidence is low; further development of a large sample of multi-center randomized controlled trials is to be confirmed. (3724) The Methodology and Methods for the Effective Treatment From the Folk to Clinical Practice in China Changhe Yu, PhD1 1Beijing University of Chinese Medicine, Dongzhimen Hospital, Beijing, China Abstract Purpose: A lot of effective therapies or treatments are been used in the folk and showed great benefit for the patients, but they are ignored or even denied by the modern medicine due to being less scientific or less evidence. Even some disease that seems to be no choice for the doctor in the hospital could be treated well by the “doctor” in the folk, due to such effective therapies. Since 2011, it has been regarded as an important task that China government has published the documentation to emphasize the collection and selection of the effective treatments from the folk, and lastly to and for the clinical practice in the hospital by the evidence-based medical methods. In addition, not all the treatment in the folk was effective, where there was some cheat. Thus, the methodology and methods for the selection are the key techniques. We discussed the characteristics and the problems of the folk treatment, offered the methods used in the selection process, and explained why such methods were chosen. Results: Inclusion of many categories such as herbal medicine, acupuncture, massages, and qigong, which were totally different from the treatment in the hospital, was the first characteristic of the folk therapies. The second characteristic was that there was few mechanism studies for the folk treatment, even something obeyed the knowledge we have already known. The third was less evidence could be used to prove the safety and effectiveness. Less evidence may resulted from that few or even no medical records were taken in the clinic, that the records were only taken when patients showed the improvement, that the safety of the treatment was little recorded, that little observation of the long-term outcomes, that nearly no one compared his own treatment with the active ones, and that the outcomes they chose for the therapeutic evaluation were not generally accepted. The principle of the selection process was that “qualitative and quantitative methods are combined, the observation and experimental trials are integrated, that clarify the elements for evaluation, and improve the levels of the evidence gradually." The reproducibility and the authenticity are first evaluated, and then the safety, effectiveness, and economy are evaluated. Thus, the interviews of the patients, possessors, and practitioners, and the qualitative method clinical observation are used first to identify the authenticity of their effectiveness. And such process also offers the elements of the treatment, including standard of practice, the indication and contraindication of patients, treatment courses, outcome index, and safety problem. And then, case series were used as the observation trial to prove the effect and safety, and to provide more indication and contraindication for the further study. Finally, the rigorous RCT or PRCT was used to prove the efficacy and effectiveness and the economic utility. Conclusions: The methods in the paper could be an effective process for the folk therapies selection, and the empirical studies should be taken to prove that it works. (3726) Development of a ResearchKit App Study for Menstrual Pain Jiani Wang, MSc1, Mike Armour, PhD2, Alizé Rogge, MSc1, Daniel Pach, MD1, Caroline Smith, PhD2 and Claudia M Witt3 1Charité—Universitätsmedizin Berlin, Berlin, Germany 2Western Sydney University, Sydney, Australia 3University Hospital Zurich, University of Zurich, Zurich, Switzerland Abstract Purpose: In recent years, the use of smartphone applications (apps) for medical needs (mHealth) has increased rapidly. Apps are a promising tool for people with different kinds of health conditions and may be particularly useful to guide and support individuals in self-management strategies. In a recent study on app-based self-acupressure for women with menstrual pain, we could show a decrease in pain and pain medication intake in the app group compared to the usual care group. For this study, 221 subjects were recruited on site by health professionals in Germany from winter 2012 until summer 2014. Our aim was to adapt the app so that it could be used internationally without recruiting on site. It should be usable for new randomized controlled trials evaluating the apps broader application. Results: For a 3-armed randomized pragmatic trial, (1) self-care recommendations plus self-acupressure, (2) self-care recommendations only, and (3) self-acupressure only, we developed an app for Apple iOS and used new technologies such as the programing language Swift, the Apple ResearchKit framework, and HealthKit. In addition to questionnaires and intervention content, the app also uses behavioral change techniques including feedback graphs and notifications, as well as calendar features. The app supports German, English, and Chinese. No tracking is used and the user remains anonymous. During the whole process, app development and trial methodology simultaneously influenced each other. Conclusions: Designing mHealth interventional studies is a multidisciplinary effort. Keeping study results relevant is difficult because of the fast development of mobile technologies. (3731) Ayurvedic Preventive Protocol for Neuro-degenerative Diseases With Special Reference to Intranasal Administration of Medicated Oil (Nasya) Aparna W Panikkasseril, BAMS, MD1 and Naveen C Venkallil, BAMS, MD2 1Indian Systems of Medicine, Kollam, Kerala, India 2Atreya Ayurveda, Moscow, Russia Abstract Overview: Adult neurogenesis is a dynamic, finely tuned process and subject to modulation by various physiological, pathological and pharmacological stimuli. There have been major advances in understanding of adult mammalian neurogenesis in the dentate gyrus of the hippocampus and from the subventricular zone of the lateral ventricle, the rostral migratory stream to the olfactory bulb. In Ayurvedic medicine, nose is considered as a major route of drug administration. It is considered as a gate way to the head (Shiras). Nasya karma is the special procedure where the drug is administered through that gateway. Ayurvedic treatment is based on the concept of Dosha – Vata, Pitta and Kapha – functional elements of body. Neurogenesis is the function of balanced vata and kapha. Abnormal increase of vatha is explained as the basic factor in the etiopathogenesis of most of the neurodegenerative diseases. Ayurvedic literature and clinical evidences has already proved that nasya is an effective treatment for many neurological, vascular, respiratory and musculoskeletal diseases affecting the upper part of the body from shoulder to the head. Pratimarsa nasya is one category of nasya where small dose of medicated oil is applied through nose every day from 7 to 70 years of age. Medicine that is administered through the nose reaches the vital point called sringataka where all channels related to the eyes, ears and throat meet and then spread to the higher centers of brain. The intranasal administration of medicines ie, Nasya helps to control vatha and kapha. Thus Pratimarsa Nasya can be applied as a preventive protocol in the management of neurodegenerative disorders. Rationale: We now witness an unprecedented situation in neurological practice with increasing number of neurodegenerative diseases. They represent more than a third of non-stroke neurological disorders today. Neurodegenerative disorders manifest as diseases or syndromes with varied combinations of cognitive, motor, sensory and autonomic dysfunctions. Currently, these are managed with medicines and surgical methods based only on symptomatology. Advances in stem cell biology of the adult brain and the discovery of adult neurogenesis have raised the hope that neurodegenerative disorders such as Alzheimer's, Parkinson's, Lewy body and Huntington's diseases etc. might ultimately become amenable to causal therapy. Ayurvedic literature and clinical evidences has already proved the effectiveness of Nasya in the effective management of neurological disorders. A preventive treatment protocol based on Nasya can be integrated into the management of neurodegenerative disorders. Objectives: Etiopathogenesis of neurodegenerative disorders as per Ayurvedic principle will be explained. The benefits of Nasya and its method of application will be explored in detail. Its possible outcome in the management of neurodegenerative disorders will be discussed. (3732) Feasibility of Data Collection in a Student Yoga Therapy Clinic Ryan Bradley, ND, MPH1, Steffany Moonaz, PhD2 and Marlysa Sullivan, MPT, C-IAYT3 1National University of Natural Medicine, Portland, Oregon 2Maryland University of Integrative Health, Baltimore, Maryland 3Maryland University of Integrative Health, Laurel, Maryland Abstract Purpose: Yoga Therapy is professionalizing through the development of educational competencies, program accreditation, and practitioner certification. Simultaneously, yoga research is growing in volume and rigor, yet most yoga therapists are not exposed to research. University-based student yoga therapy clinics provide an opportunity to gather data that will contribute to the research literature and expose students to ongoing research. This study aims to determine the feasibility of research data collection in a university-based student yoga therapy clinic. Results: Interest and engagement in research in the student yoga therapy clinic is high, with most clients enrolling in the study. Due to the nature of the student clinic schedule, return visits do not occur for many participants, making outcomes data less robust. Challenges include ensuring that data collection does not interfere with the flow of clinical encounters and technical/logistical challenges. While students are supportive of the project, the turn-over of students each term requires frequent orientation to study procedures in addition to general clinic procedures. Regular meetings including study investigators, clinic supervisors, student representatives, IT personnel, and/or facilities staff are recommended. Conclusions: Interest and participation in research is high for clients utilizing a student yoga therapy clinic. Student cooperation is also high, but some challenges exist unique to a student clinic that must be considered during planning and data collection. (3733) How Do Members of the Public Perceive Healing? A Qualitative Study Paul A Dieppe, MD1, Sara Warber, MD2, Sarah Godlingay, PhD1 and Emmylou Rahtz, PhD1 1University of Exeter, Exeter, UK 2Ann Arbor University, Ann Arbor, Michigan Abstract Purpose: Background: Although there is a growing body of research about healing amongst healers and medical professionals, little is known about how the general public conceives of healing. However, healing is an abstract concept that can be difficult to articulate. We used creative qualitative methods to address this gap in the literature. Methods: We approached members of the public visiting either a wellbeing fair or a museum. Participants used crayons to draw the first image that came to mind when we asked, “What does the word healing mean to you?” They explained their pictures to us and we recorded these short interviews. The resulting pictures and interviews were analyzed by the team using a narrative approach, with an emphasis on metaphors used. Results: Fifty-eight people took part, across the 2 sites. The pictures and accompanying explanations indicated that people have 3 principal ways of understanding healing. Some saw healing as originating from a powerful external source such as “energy,” often visually represented by the sun. Others felt that healing came from another person, who might be a health-care professional or an alternative healer. A third group believed that healing came from within; that a person can heal themselves by cultivating their inner states, although the nature of these states varied. Some in this group described a cycle of healing and regeneration as part of healing from within. This third group often drew hearts to represent healing. In addition to these 3 main models of healing, some people used combinations of the models. A small number of people described a healed state rather than a process of healing, exemplified by wholeness, such as one’s woman’s description of “a oneness … a wholeness, everything, holistic, looking at everything.” Conclusions: Members of the public have nuanced and varied understandings of the concept of healing. These different understandings build an overall model of the many elements of healing. (3734) Complementary and Alternative Medicine Integration into Georgian Health-care System Giorgi Pkhakadze, MD, PhD1, Karsten Lunze, MD, PhD2, Ilia Nadareishvili, MD1 and Nino Tabagari, MD, PhD1 1David Tvildiani Medical University, Tbilisi, Georgia 2Boston, Massachusetts Abstract Purpose: The purpose of the study was to analyze the needs to include Complementary and Alternative Medicine (CAM) introductory course into MD curricula of Georgian medical schools and postgraduate education and contribute to a framework proposal for interprofessional cooperation for step by step integration of CAM into the health-care system. Results: Use of CAM in Georgia was projected to be rising over the next years, with high satisfaction, patient-to-patient spread of information, insecurity and low trust to conventional medicine, and fear of drug side-effects pushing the patients to seek CAM services. Patients tend to not disclose CAM usage to their physicians and/or stop conventional treatment. Academia, physicians' and CAM specialist are concerned about lack of cooperation and knowledge among the stakeholders. CAM benefits are underutilized while research and development is restricted by poor understanding on the activities of each other. Patients' health is put at risk, while treatment lacks potential effectiveness and cost-effectiveness it could have. Regulatory frameworks are minimal and do not reflect the needs of the involved stakeholders. Conclusions: CAM practice and integration into health-care system in Georgia is seen as a field of opportunities by the stakeholders but lack of dialog platforms, coordinating bodies and resources prevents the progress in the problem solution. Introductory course on CAM as PCD educational component could be considered as a first step of integration process. (3736) On Field Intervention for Fear and Anxiety Secondary to Mexico City Earthquake Disaster: An Observational Case Series Leon Morales-Quezada, MD, MSc, PhD, MPH1, Diana Martinez, MD, PhD2 and Gloria Yeh, MD, MPH3 1Beth Israel Deaconess Medical Center, Boston, Massachusetts 2Trauma Center at JRI, Boston, Massachusetts 3Boston, Massachusetts Abstract Purpose: Earthquake exposure has often been associated with psychological distress characterized by acute fear and anxiety that may lead to negative long-term effects on mental health. Behavioral/neuromodulation is a novel intervention that includes (1) heart rate variability biofeedback (HRV-BFB) which has been used in traditional settings to treat anxiety and post-traumatic stress disorder and (2) low intensity/frequency median nerve stimulation (MNS) based on electroacupuncture for enhancement of parasympathetic activation. In this clinical case series, we describe preliminary effects of HRV-BFB plus MNS to manage acute anxiety as first response treatment in an earthquake disaster zone. Results: From pre- to postintervention, overall Anxiety Symptoms score decreased in all subjects (d = 2.5, SE = 0.342, P = <.001), with improvements seen in each subscale. In particular, sleep disturbances, one of the most severe problems detected at baseline decreased after intervention (d = 2.3, SE = 0.298, P = <.001). The LF/HF ratio also decreased over time (d = 0.683, SE = 0.098, P = <.001). Conclusions: Psychophysiological entrainment of HRV and neuromodulation by MNS can be used in the acute setting of a natural disaster. Behavioral/neuromodulation may be useful in mitigating symptoms associated with anxiety and stress in subjects exposed to the acute emotional trauma of an earthquake. (3737) Spinal Manipulation and Exercise for Low Back Pain in Adolescents: A Randomized Trial Roni Evans, DC, MS, PhD1, Mitchell Haas, DC2, Brent Leininger, DC2, Linda Hanson, DC, MS2, Craig Schulz, DC, MS3 and Gert Bronfort, DC, PhD2 1University of Minnesota, Minneapolis, Minnesota 2Minneapolis, Minnesota 3Children’s Hospital, Minneapolis, Minnesota Abstract Purpose: Low back pain (LBP)-related disability has increased an alarming 42% over the past 2 decades, making it the leading cause of disability globally. While there has been a long-standing belief that LBP is limited to adults, there is now substantial evidence to the contrary and a paucity of high-quality research to inform care. We conducted a multicenter randomized trial comparing 12 weeks of spinal manipulative therapy (SMT) combined with exercise therapy (ET) to ET alone. Results: Of the 185 enrolled patients, 179 (97%) provided data at 12 weeks, and 174 (94%) at 26 and 52 weeks. Adding SMT to ET resulted in a larger reduction in LBP severity over the course of 1 year (P = .007). Differences in LBP severity were small at the end of treatment (5 percentage points; P = .08) but were larger at weeks 26 (11 percentage points; P = .001) and 52 (8 percentage points; P = .009). At 26 weeks, SMT with ET performed better than ET alone for disability (P = .04) and improvement (P = .02). The SMT with ET group also reported significantly greater satisfaction with care at weeks 12, 26, and 52 (P ≤ .02). There were no serious treatment-related adverse events. Conclusions: For adolescents with chronic LBP, SMT combined with ET was more effective than ET alone over a 1-year period, with the largest differences occurring in the long-term. (3739) A Pilot Study on the Effects of Transcutaneous Auricular Vagus Nerve Stimulation on Blood Glucose Level in Type 2 Diabetes Mellitus Jie Chen1, Zhaohui Liu2 and Peijing Rong2 1Beijing Zhongguancun Hospital, Beijing, China 2China Academy of Chinese Medical Sciences, Beijing, China Abstract Purpose: To study the effects of transcutaneous auricular vagus nerve stimulation (taVNS) on blood glucose level in type 2 diabetes mellitus (T2DM) patients. Results: The FBG and 2hPBG values were not statistically significant in the taVNS group, but the reduction was 1 week ahead of the sham-taVNS group. Many HbA1c values of the taVNS group decreased after treatment, which have statistical significance, P < .05, comparison of curative effect: taVNS group total effectiveness 68.6%, sham-taVNS group 30%, the test of P < .01, with significant differences between these 2 groups. Conclusions: taVNS could reduce blood glucose in type 2 diabetic patients with various indicators of specificity; its hypoglycemic effect with the increase of treatment time and more significantly can reduce the effect of stage blood glucose. (3741) Efficacy of Ginger and Mustard Foot Baths on Psychophysiological Parameters: A Randomized Controlled Trial Bernhard Deckers, MN1, Frank Andrasik, PhD2, Szoeke Henrik, PhD3, Müller Verena, MSc1, Helmert Eduard, MD1, Jan Vagedes, MD4 and Chenchen Wang, MD, MSc5 1ARCIM Institute, Filderstadt, Germany 2University of Memphis, Memphis, Tennessee 3University of Pecs, Pecs, Hungary 4ARCIM Academic Research in Complementary and Integrative Medicine, Filderstadt, Germany 5Tufts Medical Center, Boston, Massachusetts Abstract Purpose: Footbaths are applied for enhancing body warmth of patients. Although studies abound, only a few report data on direct comparisons of ginger and mustard. The main aim of this study was to compare both substances with one another and additionally to warm water alone under standardized conditions. Results: Eighteen participants were enrolled in the study (mean age: 22 years, SD: 2.3); 6 were male (33.3%). Warmth sensations were significantly increased in both feet only after the mustard and ginger foot baths (P < .05). The warmth sensation was maintained in the group receiving the ginger bath, but the effects of the mustard bath decreased after rest (P < .05). The skin surface temperature of the legs significantly (P < .05) increased (t1 vs t0) and significantly (P < .05) decreased (t2 vs t1) with no changes between the different interventions. In the mustard and ginger groups, the subjective impression of “vitality” increased significantly (P < .05), whereas no significant changes were seen in the control condition (water alone). Conclusions: The present findings provide evidence that mustard and ginger foot baths influence the subjective impression of warmth sensation on the legs and the subjective impression of “vitality” differently than warm water alone. (3742) Resveratrol Reverses the Effect of TNF-α on Inflammatory Markers in a Model of Human Uveitis Rachel Paladino, MS1, Sierra N Miller, BS1, Karlee F Kleiber, BS1 and Donna M Byers, PhD1 1West Texas A&M University, Canyon, Texas Abstract Purpose: Uveitis is a potentially severe medical condition characterized by inflammation of the uvea, which includes the iris, ciliary body, and choroid. While there are multiple treatments for uveitis, the most common includes the use of corticosteroids and immunosuppressive or cytotoxic drugs, some of which are associated with serious side effects. Resveratrol (trans-3,4',5,-trihydroxystilbene) is a naturally occurring polyphenolic compound found in red grapes, peanuts, cranberries, Japanese giant knotweed, and legumes. Human studies have shown that it is protective against oxidative damage, supportive of vascular health, and down regulates inflammatory cytokines. Â The purpose of this study was to investigate the potential of resveratrol to attenuate the inflammatory response in a model of human uveitis. Results: In all 5 genes, tumor necrosis factor α (TNF-α) treatment induced a change in expression expected with an inflammatory response. Post TNF-α, resveratrol treatment had a significant reversal effect on expression of inflammatory markers which was either time- or dose-dependent. In addition, pre-treatment with resveratrol yielded an attenuation of the expression of several genes after subsequent treatment with TNF-α. Finally, resveratrol treatment alone had no negative effect on proliferation of ARPE-19 cells or expression of the target genes. Conclusions: These data suggest resveratrol may be a viable intervention for the treatment and prevention of human recurrent uveitis, while avoiding the negative side effects of current therapies. (3743) Attitudes and Knowledge Regarding Interprofessionalism Among Naturopathic Students Before and After a Year of Clinical Internship Education Laura T Simmons, ND1 and Kieran Cooley, ND1 1Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada Abstract Purpose: Attitudes among health-care practitioners have been shown to impact their effectiveness in collaborative practice. Naturopaths in Canada have a scope and interest conducive to collaboration; however, there is a lack of quantitative evidence evaluating their attitudes toward interprofessional care. Understanding these attitudes, as well as knowledge of other health-care providers, may assist in future integrative practice or education and training for health-care professionals, including naturopaths. In order to begin to understand the topic, a 2-phase mixed methods study was proposed to (1) assess baseline attitudes amongst naturopathic students at the beginning of their internship year and (2) follow-up with these students at the end of their internship year to assess for change and conduct in-depth qualitative assessment of themes/attitude development through additional questioning. Results: Of the 88 surveys returned initially, 77 responded in the second round of collection. Of these, 46 were completed adequately in both rounds for analysis. Eighty-seven percent of these respondents identified as female with an average age of 28.8 years. Naturopaths were labelled the most “caring” profession by interns in both rounds of data collection (P < .05). Massage therapists and nurse/nurse practitioners were seen as the next most caring by naturopathic students overall while medical doctors and pharmacists were seen as the least. Naturopaths, massage therapists, dieticians and nurses were seen as the most “subservient” professions (P > .05) while chiropractors and medical doctors were seen as the least (P < .05). Very few attitudes significantly changed within the 1 year of internship. Primarily, interns indicated that they interacted with medical doctors (85%) in collaborative care, and 91% indicated that letter was the primary form of communication. The majority of interns (89%) indicated their personal experiences contributed to their established attitudes. Conclusions: There was very little change in the attitudes of naturopathic interns over their clinical training. Further investigation and development of IPE is warranted to improve collaboration of naturopathic doctors. (3744) Integrative Health and Medicine Treatment Programs for Inflammatory Bowel Disease: Program Framework, Clinical Case Series and Health Coaching Joel Edman, PhD1 and Joseph R Libonati, PhD2 1Edman Wellness Services, Media, Pennsylvania 2Philadelphia, Pennsylvania Abstract Overview: Background: Inflammatory bowel disease (IBD) is a chronic and complex disease whose causes are not well understood. Integrative health and medicine (IHM) treatment program offers a comprehensive and potentially effective approach to management that addresses underlying causes, and may minimize medication needed, surgical interventions and may help to optimize quality of life. It is important to acknowledge, however, that there has never been a published study of an IHM treatment program for IBD. Program Description: Our hypothesis is that IBD can become acute and highly symptomatic if any of the core functional issues are imbalanced or abnormal and contribute to a viscous negative cycle of inflammation and symptoms – these include: (a) chronic/high stress and/or lack of effective and comprehensive stress management; (b) food intolerance/allergy, or lack of effective dietary guidelines; (c) gut flora/microbiome; (d) related physiological factors such as intestinal permeability and gut immune activation; and (e) other individualized influences. An IHM treatment program for IBD includes individualized and effective: (a) dietary guidelines with identification of foods/beverages and circumstances that contribute to symptoms; (b) stress management techniques and approaches that also address any underlying emotional/psychological issues; (c) targeted nutritional supplements; (d) regular physical activity/exercise; and (e) a range of other potential approaches such as massage, acupuncture/traditional oriental medicine, and others as indicated. Four case studies are presented utilizing an IHM treatment program outlined above and identifying individualized influences important in each case. Group health coaching is also presented as a potential model for conducting a study of an IHM treatment program. Conclusion: IHM programs have produced consistent anecdotal benefits for IBD patients and hold significant promise for those who may not respond effectively to standard medical treatments. Considerable future research is required to further develop our understanding of core functional area influences and the effectiveness of comprehensive IHM treatment programs. Rationale: IBD is a chronic and complex disease that is not well understood, and integrative health and medicine assessment and treatment programs may offer the best opportunity to address underlying causes and achieve optimal health outcomes. Unfortunately, there are no research studies that have examined the benefits of an integrative health and medicine treatment program for IBD, and now is the time to conduct this research. Objectives: To be familiar with the current status of integrative health and medicine research for IBD; to understand a clinical model of IBD that describes the primary core functional issues and how they interact; and to discuss different research study models that can effectively evaluate an integrative health and medicine treatment program for IBD. (3746) Vasodilation and Symptom Relief From Topical Rosemary Essential Oil in Systemic Sclerosis: A Case Report Eduard Helmert, MD1, Jörg Henes, PhD2, Tido Schön-Angerer, MD1, Bernhard Deckers, MN1 and Jan Vagedes, MD3 1ARCIM Institute, Filderstadt, Germany 2University of Tuebingen, Tuebingen, Germany 3ARCIM Academic Research in Complementary and Integrative Medicine, Filderstadt, Germany Abstract Purpose: Systemic sclerosis, or scleroderma, is a fibrosing microvascular disease that primarily manifests with skin sclerosis and Raynaud’s phenomenon, but can affect almost every organ system. The only proven topical therapy to alleviate the symptoms of Raynaud’s phenomenon is nitroglycerin gel. The purpose of this study was to evaluate preliminary data of the vasodilation and symptom relief effect of topical rosemary essential oil in a patient with systemic sclerosis. Results: Right hand (operated carpal tunnel syndrome): mean dorsal fingertip temperature change 30 min after rosemary oil was +2.1°C and −0.8°C after olive oil. Left hand (non-operated carpal tunnel syndrome): temperature decreased by −0.9°C after rosemary oil and −1.7°C after olive oil. Room temperature was 0.8°C cooler during olive oil application days. Conclusions: Topical Rosamarinus officinalis L. essential oil had a vasodilator and warming effect in a patient with advanced systemic sclerosis and Raynaud's phenomenon. (3748) The PAWS That Refresh Us: Can Animal-Assisted Therapy Have an Effect on Exam Performance in Medical Students? Susan Pressly Lephart, PhD1, Connie Jennings, MD2, Ashlee-Nicole C Hamilton, MS1 and Andrew R Hoellein, MD, FACP1 1University of Kentucky, Lexington, Kentucky 2Lexington, Kentucky Abstract Overview: Pet Therapy, also referred to as animal-assisted intervention (AAI) and animal-assisted therapy (AAT), is defined as any practice that involves animals as a part of a therapeutic or ameliorative process with the goal of positively affecting human health by utilizing animals as adjuncts to therapy. Human–animal interaction has been shown to provide numerous psychological benefits. Some of these include decreased levels of anxiety, sadness, and increased social functioning, and the secretion of the neuropeptide oxytocin during human–animal contact has been suggested to be a modulating factor. Additionally, interaction with a friendly dog can increase short-term tolerance of aversive acoustic stimulation. Based on this information, how then do first and second year medical students respond to interactions with AAT at various times around their scheduled exams? This innovative intervention is being offered at different intervals for the first and second year medical students at the University of Kentucky. These interactions include contact with AAT before or after their exams, with an occasional option for interactions both before and after, or for no interaction around the exam at all. Brief surveys are administered electronically to the medical students after each interaction for feedback specific to their reactions and perceptions of how this intervention may or may not have effected their performance or state of mind during and/or around the exam period. Rationale: A 2016 study by Rotenstein et al., found that more than 27% of medical students suffer from depression or symptoms of it, and that 11% reported suicidal thoughts. These future leaders of our medical world are at the beginning of their careers when the chance is ripe for them to learn novel, integrative management techniques for stress and anxiety. In doing so, they will not only acquire the knowledge of how AAT can help modulate their own psychological state, but also help them realize the value of implementing this modality in the lives of their future patients. Objectives: To gain an objective understanding of the value of AAT as a modality in medical student training, to obtain innovative ideas for further utilization of AAT and to acquire a model for replication and future study. (3749) Integrative Health Group Visits Nordic: A Pilot Interventional Feasibility Study to Manage People With Chronic Pain in a Nordic Inner-city Medical Clinic Katrine Bangsgaard, MSc1, Rupa S Appa, PhD2 and Shelley R Noble-Letort, PhD2 1University of Copenhagen, Copenhagen, Denmark 2Nordic Integrative Medicine, Copenhagen, Denmark Abstract Overview: Driven by the lack of evidence in the Nordic region, especially Denmark, and grounded in the North American clinical success, the primary goal of this Nordic IHM 2017 study is to help determine the effectiveness and feasibility of the integrative health group visit (IHGV) Nordic care model to manage people with chronic pain in a Nordic inner-city (Copenhagen, Denmark) outpatient medical clinic. Nordic Integrative Medicine surveyed groups of people, pre and post, who underwent a series of 6 week/8-session IHGV programs (5 – 6 groups; median 12 people/group; range: 8–16 participants) to evaluate their qualitative changes in pain (0–10 point scale and Autonomic Symptoms Questionnaire), sleep quality, and co-morbid symptoms as well as perceived stress, anxiety, and depression (Patient Health Questionnaire 15 [PHQ-15] Hospital Anxiety and Depression Scale [HADS]). Rationale: The IHGV Nordic care model combines people-centered, non-pharmacologic strategies that complement pharmacological treatments and incorporate the principles of NIH NCCIH recommended therapies for the management of chronic pain and associated symptoms. Chronic pain is a condition that 75% of North American highly esteemed academic medical centers and affiliate institutions practicing integrative medicine, report the most clinical success. Based on the overall findings of the 2016 NIH NCCIH/Mayo Clinic Review of 150 Randomized Control Trials (RCT) investigating Complementary Approaches to Pain and the 2014 study conducted by the Boston Medical Center (BMC) Integrative Medicine Group Visit (IMGV), evidence suggests that Integrative Health and Medicine (IHM) is effective for the treatment of chronic pain. Objectives: Our presentation will be delivered in 3 parts: (1) Participants will be introduced to the current status of “people centered integrated healthcare” (PCIH) being delivered in Denmark. (2) The preliminary results of the Nordic IHM 2017 study will include comparative analysis to similar studies being conducted in the USA. (3) Our objective: The improvement, development, and enhancement of future IHM mixed-methods research, including qualitative comparative effectiveness research (CER) and patient-centered outcomes research needed to aid the reformation of health-care policy in Denmark and the Nordic countries. (3750) Integrative Health Coaching for Employees With Chronic and/or Complex Health Profiles: Results of a Pilot Study From a Health-care System Corporate Wellness Program and Considerations for Best Practices Joel Edman, PhD1 and Jeffrey M Greeson, PhD2 1Edman Wellness Services, Media, Pennsylvania 2Rowan University, Glassboro, New Jersey Abstract Overview: Background: Health coaching promotes healthy lifestyles and may be particularly helpful for employees with chronic/complex health profiles. This is important since 20% of employees/patients account for 80% of health-care costs, and integrative health coaching is an innovative approach that may produce optimal health outcomes. We present data from a health coaching program that targeted health-system employees with at least 1 cardiovascular (CVD) risk factor. Fifty-four employees volunteered for health coaching (at least 1 cycle of a 6-session, 12-week program). Program Description/Results: Health coaching focused on nutrition, movement/exercise, stress management and resources/support, in a standard health coaching framework (health-vision, 3-month and 2-week goals). 40/54 completed the program. Average age was 53.3 years; 95% were female; 82.5% were Caucasian. 75% were obese/morbidly obese. 52.5% experienced hypertension, 47.5% diabetes/borderline diabetes and 40% hyperlipidemia. 20% reported chronic pain/rehabilitation needs and 17.5% reported seasonal depression/winter blues. Aerobic/weight-training exercise increased (P <. 0001) and 85% lost weight—average loss, 8.5 pounds (P < .0001). There was a significant reduction in perceived stress (P < .04) and a trend for improved sleep (P = .06). Symptom improvements included: 62.5% increased energy, 30% decreased gastrointestinal symptoms, and 20% decreased headaches/migraines. Conclusions: Health coaching can significantly decrease CVD risk (weight/exercise) and stress, and improve quality of life in employees with chronic/complicated health profiles. This is especially important for higher-risk employees who may have a vicious cycle of chronic disease and high stress, and account for a high percentage of health-care costs. Future research is required confirm these findings, develop best practices for chronic disease employee engagement, lifestyle change, and optimal health outcomes, and evaluate key markers/measures of physical/emotional well-being that can guide health transformation. Rationale: Today's model and cost of health care is unsustainable. Health coaching in general and specifically integrative health coaching is an important role that is not currently available in health care, and is essential for changing and sustaining lifestyles that help to prevent and manage diseases. This is especially important for the estimated 20% of employees/patients with chronic and/or complex disease who may account for upward of 80% of health-care costs. Objectives: To describe the results of a pilot study of integrative health coaching for employees of a health-care system with chronic and/or complex disorders; to understand the range of diseases and co-morbidities that are present in employees with chronic and/or complex disease; to identify important factors that need to be addressed as best practices for integrative health coaching are developed; and to understand the key areas of future research that will help to determine the best health outcomes for health coaching/corporate wellness programs, potential cost savings, and program implementation requirements. (3752) Implementing a Concept of Integrative Care at a Pediatric Oncology Intensive Care Unit at a University Hospital in Germany Britta Rutert, PhD1, Wiebke Stritter, MA1, Christine Holmberg, PhD1 and Georg Seifert, PhD1 1Charité Berlin, Berlin, Germany Abstract Overview: Background: The pediatric oncology intensive care unit (ICU) at the Charité University hospital in Berlin is known for excellent biomedical treatment and care, yet offers limited space for alternative forms of care. The presented project “Integrative Medicine in Care" aims at developing and implementing a concept of integrative care into conventional care of the ICU. The process asks for methodological and practice-oriented steps, which will be depicted here. Program Description: The aim of the project is to integrate anthroposophic outer applications like oil-compresses and rhythmic embrocations into the ICU of the pediatric oncology of the Charité. In anthroposophic medicine, these applications are embedded in complex philosophical medical knowledge and practices. However, for an ICU, they had to be adjusted to the structural setting of the ward and the capacities of the nurses. To understand these, qualitative research was conducted: (1) participant observation to identify the status quo of care at the ICU and during training period of applications; (2) interviews with nurses on job satisfaction; (3) interviews with parents on integrative care; and (4) interviews with health personnel (doctors, nurses, and therapists) of anthroposophic clinics. Subsequently, the data were analyzed and a concept of integrative care was developed from the data. Conclusion: Implementing integrative care at an ICU of a German hospital meets challenges and chances. High work-related stress, lack of staff members and time as well as structural constraints impeded the development and implementation process. These were compensated with the development of reduced versions of the anthroposophic applications, which were easier to apply in a stressful setting. These “reduced" versions were offered to patients on a regular basis. Additionally, more complex applications were also offered according to needs of patients. Rationale: The presentation describes the attempt to integrate anthroposophic care into conventional care and thus advances a biomedical context by integrating alternative modes of care. Objectives: They will know how a new system (integrative care) was integrated into an existing system (conventional care) in a University clinic setting, which is primarily biomedically oriented. (3753) Modified Complete Decongestive Therapy for the Treatment of Pediatric Klippel-Trenauny Syndrome Elizabeth A Cross, PT, DPT, MSW, CLT1 1Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Abstract Overview: Case Description: Prior to evaluation by a Certified Lymphedema Therapist (CLT), all 3 patients had been treated with surgical and non-surgical interventions, which had not been effective in managing the edema in one extremity. All patients were referred to the lymphedema team for persistent edema in the affected limb. All 3 patients demonstrated decreased functional mobility and sensory tolerance of the affected limb which limited age appropriate activities. The patients with lower extremity edema had a history of wounds which were not healed at initial evaluation. Modified complete decongestive therapy (CDT) was used to decrease limb edema, provide consistent, well-fitting compression, and educate families for long-term care of this chronic condition. We choose to assess 3 cases of children of the same age and diagnosis to compare a similar group to help us understand the effects of our work on 1 diagnostic group then extrapolate the findings to work with other lymphatic disorders. Rationale: Outcomes: Edema reduction was achieved with use of compression bandaging and bandaging-alternative garments. Patients were fitted for custom garments for night and daytime wear that resulted in successful maintenance of limb volume. Volumetric measurements and serial photographs were taken to monitor differences in limb during course of therapy, in addition to, changes in limb volumes and appearance following interventions. Volumetric differences between the affected and unaffected limbs were as follows: Patient 1 reduced from 97% to 71%, Patient 2 reduced from 151% to 107%, and Patient 3 reduced from 29% to 17%. The draining wounds in the 2 males with lower extremity edema were healed and all 3 patients had improved sensory tolerance in the affected limb. Additionally, all 3 patients demonstrated improvements in functional age appropriate activities, which will be further described in this case review. This topic is of tremendous interest to many professionals as we explore the importance of the lymphatic system on the physical and physiological development of the child. It has required a collaborative effort of many professionals to understand and design creative interventions to improve the lives of the children and their families (GI, Oncology, Orthopedics, Pulmonary, Cardiac, Hematology, Plastics, Interventional Radiology, PT, OT). It is exciting to be on the cutting edge of understanding and intervening with the lymphatic system and the effects a dysfunctional system have on the development of the child and as we explore new ways to effect the developing systems and manage these lymphatic diagnoses with cost effective and nonsurgical interventions. The interventions we have determined that are effective for most of the lymphatic disorders we encounter are simple and are easily taught to the families which allows better involvement of the family in the treatment process and better advocacy of the patient needs as they understand the particular issues related to the particular lymphatic disorder. Objectives: Discussion: Modified CDT led to effective outcomes in achieving the goals of edema reduction, wound healing and improvement of functional limb use. These case reviews present success with conservative management using modified CDT as an intervention for pediatric patients with Klippel-Trenauny syndrome. This intervention lays the groundwork for guidelines for effective and appropriate treatment of edema in children with KT syndrome. The issues we addressed with KTS have allowed us to explore the options with our work with all lymphatic diagnoses. As we work with multiple professionals now diagnosing the lymphatic disorders that we once knew nothing about and now are diagnosing at very young ages and these interventions are easy to administer with very little equipment therefore they are effective worldwide. Additionally, we want to share our findings in an effort to encourage professionals worldwide to assist in the exploration of the lymphatic system and the influence it has on all organs and our physiological performance. Keywords: pediatric lymphedema, primary lymphedema, Klippel-Trenauny (3755) Feasibility and Acceptability of Adapted Mindfulness Training to Treat Chronic Pain in the Military Nakisa Asefnia, BA1, Kristine Rae Olmsted, MSPH2, Shari Miller, PhD2, Alex Buben, BA2, Michael Bartoszek, MD3, Michael Butler, PhD4, Susan Gaylord, PhD4 and Carrie Brintz, PhD4 1University of South Carolina, Barnwell College, Columbia, South Carolina 2RTI International, Durham, North Carolina 3Womack Army Medical Center, Fort Bragg, North Carolina 4Chapel Hill, North Carolina Abstract Purpose: Service members experiencing chronic pain have the highest rates of medical discharge from military service. Disability costs are over $1.5 billion annually. Pharmacological approaches may be ineffective, produce side effects, and lead to addiction. The purpose of the study is to test the acceptability and feasibility of a live web-based mindfulness training with active duty service members experiencing chronic pain. Results: Four participants enrolled in the training. At least 3 participants attended each live video session, and there was 100% participation, as participants viewed the recorded sessions on the tablet when unable to attend live. Participants reported the platform and tablet were easy to use and that they used the tablet to review sessions and practice the mindfulness skills. All participants reported that didactic material was clear, informative, and engaging, and that the mindfulness skills were beneficial for managing pain and stress. Suggestions included making the app available on a personal phone or computer, and shortening the sessions. Conclusions: An interactive web-based mindfulness training was feasible and acceptable to implement with active-duty military personnel with chronic pain. This study addresses the critical need for increasing accessibility of complementary, non-pharmacological approaches for managing chronic pain and co-occurring conditions in U.S. military personnel. Future research should examine effects of the training on pain, medication use and co-occurring conditions. (3756) A Mindfulness-Based Intervention for Low-income African-American Women With Depressive Symptoms Delivered by an Experienced Instructor Versus a Novice Instructor Judith T Moskowitz, PhD1, Amy Yang, MS1, Elizabeth Waldron, BA1, Carly Maletich, MA1, Inger Burnett-Zeigler1 and Sunghyun Hong, BA1 1Chicago, Illinois Abstract Purpose: In the present study, we evaluate the feasibility of a mindfulness-based intervention for depression delivered to women in a Federally Qualified Health Center (FQHC), pilot a streamlined mindfulness teacher training protocol for FQHC staff, and examine the distribution and variability of psychological outcomes for participants in groups led by an experienced instructor as compared to FQHC staff instructor who received the streamlined training. Results: Depressive symptoms and stress significantly decreased, and mindfulness significantly increased in the experienced and novice instructor groups. In the novice instructor group, there was also a significant increase in well-being and functioning. The change in depressive symptoms, stress, functioning, and well-being was significantly greater in the novice instructor group than the experienced instructor groups. Conclusions: Providing streamlined training in mindfulness based interventions to community based health-care staff provides an opportunity to increase access to effective treatments for mental health symptoms in underserved communities. (3757) Usurping the Olympian Gods' Nectar: A Botanical and Biochemical Review of Flower Nectar for Its Possible Therapeutic Uses Tamima O Mourad1 1Universidade Anhembi Morumbi, Sâo Paulo, Brazil Abstract Overview: Flower nectar is not a “flat" substance. This paper presents it from a botanical biochemical perspective; and as food supplement, as it is one of the 3 main constituents of Flower Essences. The study of nectar biochemical constitution gained momentum in the mid-1990s, in the field of botany. Such studies were undertaken to investigate the relationship between plants and their pollinators; as an award, not only attracting them but also stimulating pollinator behavior. This research is an interdisciplinary study of nectar, consisting of a bibliographical review of the biochemistry of nectar, its possible effects in human consumption through the use of Flower Essences. Rationale: Integrative medicine has an inclusive tendency toward therapeutic practices that had not been before accepted in health sciences. An academic review of the biochemical constituents of flower nectar assists in the objective understanding of what biochemical constituents are present in the Flower Essences used for therapeutic purposes for almost a century. Objectives: Among the objectives of this study: (i) constituents that are only present in the nectar, and no other plant parts, (ii) biochemical composition of nectar that serve as an active principle to stimulate pollinator behavior, and (iii) biochemical composition in flower nectar that can be considered useful for therapeutic use. (3758) Clinical Pain Characteristics and Placebo Analgesia in Patients With Temporomandibular Disorder Luana Colloca, MD, PhD1, Nathaniel Haycock, BA1 and Titilola Akintola, BSc1 1Baltimore, Maryland Abstract Purpose: Considerable gaps exist in the understanding of how endogenous pain modulation (EPM) influences clinical pain. Differences in EPM may account for the high variability observed in the pain experience of chronic pain patients. Here, we examine whether the nature of clinical pain can impact placebo analgesia in chronic orofacial pain patients, specifically those with temporomandibular disorder (TMD). Results: Findings showed no statistically significant difference in placebo-induced analgesia between TMDs and controls. There was a main effect of condition in both TMDs, F(1, 29) = 24.72, P < .001, and healthy controls, F(1, 30) = 27.31, P < .001. There were no significant correlations between placebo analgesia and duration of pain (rs  = .01, P = .374), severity of pain (rs  = .01, P = .357), overall pain (rs  = .13, P = .236), and likelihood of neuropathic pain (rs  = .06, P = .577). Conclusions: This is the first evidence that TMD patients experience substantial placebo analgesic effects that are linked to the reward system. Pain type, severity, duration, and likelihood of a neuropathic component did not impact placebo response, indicating that chronic orofacial pain does not affect the magnitude of placebo analgesia. Through further research, we can learn to optimize clinical outcomes by activating EPM to induce placebo analgesia. (3759) Nighttime Use of Far-infrared Emitting Ceramic Shirts Increases Quality of Sleep in Young Baseball Players Alan Letton, PhD1, Shannon Vissman, PhD1, Francisco Cidral-Filho, PhD2 and Daniel F Martins, PhD2 1Multiple Energy Technologies, Washington, Pennsylvania 2University of Southern Santa Catarina, Palhoça, Brazil Abstract Purpose: Far-infrared has been shown to reduce muscle pain and improve physical functioning and health. The purpose of this study was to evaluate the effect of nighttime use of far-infrared emitting ceramic shirts upon quality of sleep of young baseball players. Results: In comparison to placebo group results, the use of cFIR shirts increased overall quality of sleep (P < .01), while reduced sleep latency (P < .01) and sleep disturbance (P < .01). Conclusions: Nighttime use of far-infrared emitting ceramic shirts increases quality of sleep, reduces the length of time to falling asleep (sleep latency) as well as the influences of sleep disturbances upon sleep in young baseball players. These results are aligned with literature data further support the current growing use of cFIR garments to improve general well-being and quality of sleep. (3760) Placebo Analgesia and Neuropathic Pain: Insights From a Novel Rodent Model Luana Colloca, MD, PhD1, Titilola Akintola, BSc1, Radi Masri, DDS, BS, PhD1, Asaf Keller, PhD1 and Paige Studlack, BA 1Baltimore, Maryland Abstract Purpose: The lack of effective therapies for chronic pain has been cited as a major contributor to the opioid epidemic and necessitates the advancement of research into alternative therapies. Placebo analgesia has emerged as a potential approach to reduce opioid use by interspersing with placebos. The development of an animal model of placebo analgesia in chronic pain is essential to a full understanding of its neurobiological mechanisms and a complete assessment of its therapeutic potentials. Results: Fentanyl-conditioning produced a placebo analgesic effect on test day when animals received only saline, resulting in significantly reduced scores (P = <10−3) on the facial grimace scale, a validated metric for assessing the affective component of pain. Saline also significantly reduced mechanical sensitivity (P = .0035) in Fentanyl-conditioned animals. Control animals who were conditioned with saline (and never received Fentanyl) showed no significant reduction in pain ratings on either metric. Conclusions: This study provides evidence for the first time that placebo analgesia can be induced in an animal model of chronic pain. We show that placebos may have utility in alleviating the affective and reflexive components of chronic pain in rats. Furthermore, this study highlights a robust animal model of placebo analgesia that could be useful in the development of more effective chronic pain therapies. (3762) National Board Certification for Health and Wellness Coaching: Updates and Outcomes in a Pioneering Field for Health-care Transformation Cynthia Schultz, MA, LP1, Meg Jordan, PhD, RN, CWP, ACC2, Margaret Moore, MBA3, Raja Subhiyah, PhD4, Karen Lawson, MD5 and Ruth Q Wolever, PhD5 1Minneapolis, Minnesota 2California Institute of Integral Studies, San Francisco, California 3McLean Hospital, Harvard Medical School, Boston, Massachusetts 4National Board of Medical Examiners, Philadelphia, Pennsylvania 5Nashville, Tennessee Abstract Overview: The demand to manage burgeoning chronic disease has led to the emergence of job roles such as health and wellness coaches (HWC). As use of the titles “health coach” and “wellness coach” have increased dramatically, so has the need to ensure consistency, quality and safety for HWC provided in both practice and research. Clear and uniform role definitions and competencies are required to ensure appropriate scope of practice, to allow best practices to emerge, and to support the implementation of rigorous research. To professionalize the field, a collaborative volunteer non-profit organization, the National Consortium for Credentialing Health and Wellness Coaches (NCCHWC), gathered input since 2010, and changed its name and structure to International Consortium for Health and Wellness Coaching (ICHWC) in 2017. This presentation will discuss how this group gathered the field to clarify core competencies in HWC, applied best-practice processes to conduct and validate a Job Task Analysis, and garnered the attention of the National Board of Medical Examiners (NBME). In collaboration with NBME for the past 2 years, we jointly launched the inaugural national certification exam with over 1300 applicants in September 2017. With a senior statistician from NBME, we will review the process of building the national exam. We will also consider how the ICHWC-NBME partnership has brought forth a uniform job definition, with clarification of core skill competencies, and needed training standards with a process for educational program approval. The momentum in building this field is supported by many stakeholders. The potential of HWC to significantly transform health care toward a truly relationship-centered and client-empowering system, and the next steps to move the field forward, will be explored. Rationale: The demand to manage burgeoning chronic disease has led to the emergence of job roles such as health and wellness coaches (HWC). As use of the titles “health coach” and “wellness coach” have increased dramatically, so has the need to ensure consistency, quality and safety for HWC provided in both practice and research. The successful launch of the first national board certification for HWC helps to ensure quality and safety as well as better define the field. Objectives: Participants will recognize the need for consistency in job definitions and professional practices for health and wellness coaching (HWC) to advance education, clinical practice and research; become aware of the brand new National Board Certification process and consider its role in advancing practice both for current health providers, as well as new health and wellness coaches; and define the core competencies of health and wellness coaching (HWC) and identify how they complement and expand those in other health and medical professions. (3763) Warmth Distribution in Adolescent Anorexia Nervosa Jan Vagedes, MD1 and Cara Simmance, PhD2 1ARCIM Academic Research in Complementary and Integrative Medicine, Filderstadt, Germany 2University of Tuebingen, Tuebingen, Germany Abstract Purpose: Anorexia nervosa (AN) is associated with thermoregulatory disturbances such as hypothermia. However, few studies have explored body warmth in AN patients. In this study, we assessed the body surface temperature distribution in adolescent AN patients using high-resolution infrared thermal imaging, and through a patient questionnaire, and explored how this differed between intervention and control group and length of treatment. Results: The AN patients were significantly colder in all chosen body domains at t1 compared to healthy controls, except the abdomen area: canthi of both eyes (−0.76°C, P < .001), face (−1.36°C, P < .001), forehead (−0.55°C, P < .01), nose (−4.25 degrees, P < .001), hands (−3.11°C, P < .001), feet (−2.54°C, P < .001), and abdomen (+0.48°C, P < .05). The questionnaire findings supported these results. Differences between the intervention and control groups noted at t1 were significantly reduced by t2 and t3. Conclusions: Our findings suggest that abnormities in the body warmth distribution of AN patients are reversible after having received an AN specific treatment. Reducing the loss of warmth could improve therapeutic outcomes in AN patients and be a predictor of recovery, and should be investigated in further studies. (3764) Mindfulness is Associated With Sleep Quality Among Patients With Fibromyalgia Yuan Zhang, PhD1, Xingyi Han, MPH2, Lori L Price, MAS, MLA3, Michelle Park, BA4, Chenchen Wang, MD, MSc4 and Raveendhara R Bannuru, MD, PhD4 1University of Massachusetts Lowell, Lowell, Massachusetts 2Tufts Medical Center, Boston, Massachusetts 3Tufts University, Boston, Massachusetts 4Tufts Medical Center, Boston, Massachusetts Abstract Purpose: Patients with fibromyalgia commonly experience sleep disturbance. Previous studies suggest higher mindfulness may be associated with better sleep quality in people with chronic pain conditions. However, the role of mindfulness in fibromyalgia remains understudied. We examine the relationships between mindfulness and sleep disturbance, depression, and pain interference in fibromyalgia. Results: A total of 176 patents with fibromyalgia were included (93% female, mean age: 52 ± 12 years, BMI: 30 ± 7 kg/m2, 60% white). Higher mindfulness in patients was associated with better sleep quality (r = .22, P = .003) as well as less sleep disturbance (r = .23, P = .002), chronic pain (r = .31, P < .0001), and depression (r = .59, P < .0001) (Table 1). Chronic pain mediated the associations between mindfulness and sleep quality (42.7% of total effect, P = .05) and mindfulness and sleep disturbance (33.8% of total effect, P = .03) (Figure 1). Conclusions: Higher mindfulness is associated with better sleep quality in people with fibromyalgia, with chronic pain mediating this relationship. Longitudinal studies designed to increase mindfulness in patients with fibromyalgia are warranted. (3767) Addressing Pain With Integrative Medicine at a Large Freestanding Children’s Hospital Sanghamitra M Misra, MD1, Evelyn C Monico, MD1, Esther Kim, BS1, Grace Kao, PhD1, Caroyl Gilbert, RN, PNP-BC1, Monica Marcus, DO1, Meesha Khatker, BS1 and Angelo Giardino, MD1 1Baylor College of Medicine, Houston, Texas Abstract Purpose: At our large pediatric hospital, we launched an IM inpatient pilot consult service to investigate the feasibility; parent and patient interest; and benefits of a coordinated IM consult service to address pain in children. Results: Thirty-four patients (14 male) were enrolled in the study. Nineteen of the subjects, 21 of their mothers and 18 of their fathers used CAM in the last 1 year. Ten of the patients were covered by Medicaid/CHIP, and 21 had private insurance. The patients were taking between 1 and 5 pain medications at time of consult. Before our intervention, 33 parents were interested in their child receiving IM services, 3 parents were nervous about the IM services, 29 felt that IM services would benefit their child’s pain, and 33 parents felt that our hospital should have an IM consult service. One parent noted that her child was more irritable after an IM therapy but there were no other adverse events. All the 15 families interviewed felt that IM services helped their child’s pain, helped their child’s mood, and that our hospital should have an IM consult service. Conclusions: During this national opioid crisis, integrative techniques can be helpful to address pain without significant side effects. (3768) Manual Therapy Reduces Nociception and Oxidative Stress in an Animal Model of Complex Regional Pain Syndrome Type 1 Leidiane Mazzardo-Martins, PhD1, Juliana Stramosk2, Ana Cristin, a C Kuci2, Fabricia Petronilho, PhD2, Lucineia G Danielski2, Drielly Florentino2, Daniela D Ludtke3, Afonso Salgado, PhD4, Francisco Cidral-Filho, PhD4 and Daniel F Martins, PhD4 1University of Federal of Santa Catarina, Florianópolis, Brazil 2University of Southern Santa Catarina, Tubarão, Brazil 3University of Federal of Santa Catarina, Palhoça, Brazil 4University of Southern Santa Catarina, Palhoça, Brazil Abstract Purpose: Evaluate the analgesic and anti-oxidative effect of manual therapy in an animal model of complex regional pain syndrome type 1 (CRPS-I). Results: I/R induced marked and long-lasting mechanical hyperalgesia. Acute AJM reduced mechanical hyperalgesia (days 2, 7 and 11 post-I/R) with significant results 0.5 h (P < .05) and 1 h (P < .5) after AJM. Repeated daily treatments (days 2–7 and 7–11) also decreased mechanical hyperalgesia 30 min after treatment (P < .05). On day 2 post-I/R paw tissue concentrations of TBARS and protein carbonyls were elevated; while levels of CAT and SOD activity were decreased in relation to Sham I/R. AJM significantly prevented TBARS and protein carbonyls increase, as well as prevented the decrease in CAT but not SOD activity. Conclusions: Manual therapy reduced nociception and oxidative stress in an animal model of CRPS-I. (3770) Evidence-based Medicine in Homeopathy: A Review of Study Designs in Homeopathic Treatment of Anxiety and Recommendations for Future Research Sonia Malani1 and Steven LaBrecque, MPH1 1Bastyr University, Seattle, Washington Abstract Purpose: In the last 20 years, the migration to evidence-based medicine (EBM) has been rapid and pervasive. The main reasons for this are the implementation of electronic medical records, the internet, an increasing number of point-of-care tests, and the rising costs of health care. EBM was originally defined in the 1990s as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Randomized controlled trials (RCTs) have been considered the gold standard of EBM. In well-designed trials of significant size, the randomization evenly distributes known and unknown factors among both the control and intervention groups, and reduces the potential for confounding variables. Since the 1990s, the definition of EBM has been revised in the 21st century as the integration of clinical aptitude, patient values, and the most promising evidence available to aid the process of decision-making in patient-centered health care (see Figure 1). Thus, the clinical experience of the health-care professional is equally as important as the research at hand in this this revised definition. Opponents of homeopathy often claim that it is not based in scientific evidence nor can it be studied based on principles of EBM, however, this is simply not the case. This misinformation highlights the issue with dogmatic thinking in the conventional medical community fueled by the historical stigma of homeopathy in the American health-care system. Homeopathic pathogenic trials (HPTs) have long been the pillars of scientific studies on homeopathy. In fact, the design method was one of the first examples of systematic research on medicine, and it served as the basis for which the first major experiment with a placebo control group occurred in Nürnberg, Germany in 1835. HPTs, or “provings,” were initially developed by Dr Samuel Hahnemann, a German medical doctor in the 19th century. In homeopathic provings, a particular substance (ie, plant or animal material) is diluted, shaken, and then tested in healthy human subject volunteers until they begin to show symptoms. The symptoms are then recorded by each subject and the complete list of symptoms eventually becomes the materia medica for the remedy based from that particular substance. Homeopathy is embedded in the philosophy of “like cures like,” meaning that a person who has certain symptoms is treated homeopathically with an ultra-diluted remedy that would normally produce those symptoms in an otherwise healthy individual. There have been a number of research studies conducted in recent years on the treatment of anxiety with homeopathic remedies in a variety of study designs, ranging from observational animal studies to randomized, double-blind, placebo-controlled trials. According to the Anxiety and Depression Association of America, anxiety is one of the most prevalent mental illnesses and affects 40 million adults in the United States age 18 and older each year. Since homeopathy is known to take into account the mental, emotional, and physical manifestations of a disease, it has had particular success in patients with a diagnosis of generalized anxiety disorder. This current presentation reviews the literature and highlights how the published research on homeopathy can follow the principles of EBM and guide clinical decision-making in the patient encounter. Results: Included in Methods as one combined section. Conclusions: Homeopathy is often falsely accused that it is not based in scientific evidence; however, this review demonstrates how the principles of EBM have been applied to homeopathy in the last 20 years. It is this clinical research that serves to provide validation of HPTs that have been conducted over the past 2 centuries by medical doctors like Dr Samuel Hanhemann. EBM has strengthened clinical recommendations within population medicine, however, some researchers claim that EBM often fails to provide evidence to guide decisions in clinical care for individual patients. Despite their strengths, RCTs often have substantial limitations. Although they can have significant internal validity, RCTs sometimes lack external validity. For example, generalizations of findings outside the study population may actually be invalid. In addition, RCTs have increasingly high costs with a major time commitment, which can lead to reliance on surrogate markers that may not correlate well with the outcome of interest. This all reduces the ability of RCTs to keep up with clinical advances, and so new products and standards of care are often developed prior to completion of the research studies. These pitfalls of the traditional EBM model underscore the shift toward an era of personalized medical care that is more patient-centered and holistic-based. There are several challenges with respect to EBM-oriented research on homeopathy, much of which stems from the dilution factor of the homeopathic substance. Homeopathic preparations typically start as 6C potencies and progress to more dilute potencies (ie, 12C, 30C, 200C). By the time the dilution factor reaches 12C, there is theoretically no active substance left in the preparation because the dilution has surpassed Avogadro’s number of 6.022 × 1023. Homeopathic treatment of anxiety was the topic of choice for this literature review because of homeopathy’s ability to address the mental, emotional, and physical complaints of a patient. Since a homeopathic intake is customized to the symptomatology and experience of each patient, changes in anxiety symptoms can be measured using clinical assessments like the GAD-7 questionnaire in future research. Based on our understanding of homeopathic prescribing, we recommend the following suggestions for future research on homeopathic protocols for anxiety: (1) A comparison of a specific remedy at a particular potency (ie, 200C dilution factor) with a placebo control; (2) Blinding of participants, but not the homeopath because he or she needs to be able to examine the patient as a whole to determine the most accurate remedy for the particular patient; (3) Selection of the top 4–5 strongest rubrics by the homeopath that best fits the case; (4) Implementation of a GAD-7 assessment prior to treatment and at the follow-up appointment 4–6 weeks after the start of treatment. An added strength to the potential study would be to ask the participants to guess which experimental group they thought they were in throughout the study. In this case, the study would be less biased if there is no difference in the guesses between the groups, indicating a strong blinding procedure. (3772) Effects of Mantra Meditation Versus Music Listening on Knee Pain, Function, and Related Outcomes in Older Adults With Knee Osteoarthritis: A Pilot Randomized Controlled Trial Kim Innes, PhD, MSPH1, Terry K Selfe, DC, PhD2, Sahiti Kandati, MPH, DDS1, Caitlin Montgomery, MPH1, Hannah Bowles, MS3 and Zenzi Huysmans, MS4 1West Virginia University School of Public Health, Morgantown, West Virginia 2University of Florida, Gainesville, Florida 3West Virginia University School of Medicine, Morgantown, West Virginia 4West Virginia University College of Physical Activity and Sport Sciences, Morgantown, West Virginia Abstract Purpose: Although meditation and music listening (ML) have been shown to reduce pain and improve other outcomes in certain chronic pain populations, research in osteoarthritis (OA) is sparse. In this pilot RCT, we compare the effects of these two simple practices on knee pain, function, and related outcomes in older adults with knee OA. Results: Participants were aged 51 to 74 (X = 58.5 ± 1.4) years, 82% white, and 68% female. Twenty participants (91%) completed the study (9 MM, 11 ML). Compliance was excellent, with participants completing a mean of 12.1 ± 0.8 sessions/wk. Relative to baseline, participants in both groups demonstrated improvement at 8 weeks in all core outcomes, including knee pain (KOOS, P ≤ .03; NRS, P ≤ .03), function (MM, P < .02, ML P < .1), and perceived OA severity (P ≤ .04), as well as in mood (P ≤ .05), perceived stress (P ≤ .04), and QOL (Physical Health Component, P ≤ .01). The MM group showed greater improvements than the ML group in mood and sleep (P < .04), and a tendency toward greater improvements in certain domains of knee-related function and QOL (P < .09), QOL-Mental Health (MH) (P < .07), and kinesiophobia (P = .09). Conclusions: Findings of this pilot RCT suggest that a simple MM, and possibly, ML program may be effective in reducing knee pain and dysfunction, decreasing stress, and improving mood, sleep and QOL in older adults with knee OA, with improvements in mood and sleep that were significantly more pronounced in the MM group. (3773) Effects of Qigong on Interoceptive Awareness in Breast Cancer Survivors With Persistent Post-surgical Pain Kamila Osypiuk, MS1, Gloria Vergara-Diaz, MD2, Roxanne Solis Quinn, BS3, Winnie Ng, BS3, Paolo Bonato, PhD2, Jennifer Ligibel, MD3 and Peter M Wayne, PhD1 1Brigham and Women's Hospital, Boston, Massachusetts 2Spaulding Rehabilitation Hospital, Boston, Massachusetts 3Dana Farber Cancer Institute, Boston, Massachusetts Abstract Purpose: Persistent post-surgical pain (PPSP) is a prevalent and distressing side-effect of breast cancer treatment. A multifaceted mind-body intervention, such as Qigong, which incorporates physical activity and meditative and psychosocial components, may address underlying causes of the pain. Interoceptive awareness has been purported to contribute to the benefits of mind-body interventions. In this single-arm pilot study, in addition to evaluating the feasibility of a 12-week Qigong program for breast cancer survivors, the effects of this intervention on interoception are explored. Results: Twenty-one women with mean age of 54 (SD: 10.18) and 4.54 (SD: 2.81) years since surgery were enrolled. Eighteen subjects completed follow-up outcome assessments (2 withdrew for health reasons, 1 was lost to follow-up). Subjects attended on average 6.52 (SD: 3.37) Qigong classes. Among subjects who completed the study (n = 18), improvements were observed in 7 of 8 domains of interoception measured by the MAIA (“attention regulation,” “body listening,” “emotional awareness,” “noticing,” “self-regulation,” “trusting,” and “not worrying”). The greatest mean differences were observed in “self-regulation” (+1.43 CI = 0.88, 1.98; P < .0001), “trusting” (+1.46 CI = 0.88, 2.04; P < .0001), and “body listening” (+1.43 CI = 0.74, 2.11; P = .0002). Conclusions: Delivery of Qigong for women with PPSP is feasible and shows promise in increasing interoceptive awareness, particularly impacting one’s ability to listen to and trust the body, and use awareness of body sensations to regulate emotion. Future studies evaluating the clinical and psychophysiological benefits of Qigong and the relationship between interoception and other key issues affecting breast cancer survivors, eg, pain, self-esteem, and perceived stress, are warranted. (3774) The Effects of Pranayama on the Autonomic Nervous System Alison Lacombe, PhD1, Ryan Bradley, ND, MPH1, Doug Hanes, PhD1, John Phipps, PhD1, Erica Sharpe, PhD1, Jan Taylor, BA1 and Ryan Heer, BS1 1National University of Natural Medicine, Portland, Oregon Abstract Purpose: Pranayama deep breathing (PDB) component yoga involving conscious regulation of breath. Sheetkari (SK) and Sheetali (ST) are two forms of PDB purported to have specific physiological effects. Recent research demonstrated PDB could modulate autonomic nervous system (ANS) markers such as heart rate variability (HRV). The purpose of this study is to measure the effects of modifiable SK and ST practice parameters on ANS activity, as an intermediate step to investigating PDB in clinical conditions associated with ANS dysregulation, such as hypertension. Results: Currently, n = 10 participants have enrolled and n = 3 have completed all 5 study conditions. We anticipate n = X participants will have completed by the time of presentation. Our primary outcome is changes in HRV statistics, which will be reported between practice conditions. Secondary outcomes will determine the interrelations between measures of HRV and changes in respiration rate variability to determine the impact of pacing on the ANS. Conclusions: Measuring the impact of modifiable components of mind-body interventions on the reliability of their purported mechanisms of action is a critical step toward developing clinical trials. The proposed presentation will demonstrate the impact of key PDB practice conditions on the purported mechanism of SK/ST. (3775) A Study of Reiki Practitioners’ Ability to Detect Human Energy Fields Gabriel Moss1, Sean Hobson, BA2, Richard T Lee, MD1, Bethanny Bristol, BA2, Ming Li, PhD1 and Katherine Daunov, MSN, CNP2 1Case Western Reserve University, Cleveland, Ohio 2University Hospitals, Cleveland, Ohio Abstract Purpose: Reiki is a form of energy healing that is gaining popularity. This practice commonly includes energy scanning to focus the treatment. This study examines the capability of Reiki practitioners (RP) to detect human energy fields (HEF). Results: A total of 67 RP participated in this study with a mean age of 58 (range 27–77) and most were female (61). The majority were Reiki Masters (60) and practiced Reiki an average of 11.4 years (±6.2, 1.5–24). All RP were able to complete 20 trials for a total of 1340 individual trials with each taking an average of 18.7 s (±20.1, 3–190). RP had a mean success rate of detecting HEF of 25.4%, (median 5 ± 1.9, 2–11). Two subjects met criteria for repeat testing with results of 12/40 and 15/40. Reiki Masters were more likely to detect HEF (>25% accuracy) than RP level 2 (P = .03). Years of experience (>10), age (>58), sex, and hand dominance did not correlate to an increase in detecting HEF. The control group of 25 non-energy trained volunteers had a mean success rate of 24.2% (median 5 ± 1.7, 2–8). Conclusions: In general, RPs’ ability to HEF in this study was equivalent to chance and similar to a control group of non-energy trained volunteers. (3780) Unsupported in a Changing Landscape: Learning Technologies in Integrative and Complementary Medicine Education Provision: Results of an International Survey of Faculty Alastair Gray, MSc1 1University of Technology Sydney, New York, New York Abstract Purpose: Closely related to the continuing popularity of complementary medicine (CM) has been an increased number of enrolments at CM education institutions across the public and private tertiary sectors. Despite growth in CM education and a number of significant challenges and changes facing higher education more generally there has been very little peer-reviewed research examining CM education. In direct response to this important gap, this paper reports on faculty perceptions of attitudes to technologies in general, technologies in CM academic work and perceptions of support from colleges. Results: Responses to the survey (n = 91). Striking results highlight that CM academics are clearly disgruntled about technology in their lives and have strong attitudes to it. They reported student’s skills and behaviors as different than before as a consequence of technologies. They see their jobs as changing, see technologies as an impediment to good teaching and having a major impact on their jobs. Staff do not feel supported. Applying Rogers Diffusion of Innovation theory there were more self-reported innovators at NUNM, more early adopters at Endeavour, more early majority at Endeavour, more late majority at NUNM. There were no self-reported laggards at either institution. Conclusions: The data points to supporting the clear trends in the university sector worldwide, but also key differences, with some resistance to the use of technologies, due to the unique values, demographics and psychographics of those who involved in CM education. This has significance of the CM and IM industries as a whole. Comparison with concurrent student surveys highlights a deep digital divide between a new generation of health-care providers and their teachers. It also shows an important difference across countries. It highlights that the 2 dominant providers of CM are at different places in their educational provision. (3783) What Social Networks Teach Us About Patient–Provider Communication on Pain Yasmine Kloth, MS1 and Ken Deutsch2 1National Center for Complementary and Integrative Health, Bethesda, Maryland 2JPA Labs, JPA Health Communications, Boston, Massachusetts Abstract Purpose: We aim to understand how patient conversations and health-care provider (HCP) conversations on pain are structured on Twitter. By identifying how information is spread by and between these audiences, organizations will be better poised to develop and share materials that can help facilitate communication between HCPs and patients, with an end goal of improving a shared decision-making process around pain management. Results: Preliminary data indicate that chronic pain patients mostly follow each other, get information from like-minded sources, and are more likely to cite consumer websites. In comparison, cancer patients are more likely to follow specialists than their chronic pain counterparts and cite health-focused sources such as jamanetwork.com and cancer.gov. Conclusions: In the social media sphere of Twitter, patient and provider discussions around pain are less interactive than those in oncology. Pain patients do not follow medical professionals or share medical or health-related information on Twitter to the same extent that oncology patients do. This could be because pain can be a part of many different conditions and as a result, pain patients are not organized online in the same way oncology patients are; likewise, pain patients might not have a central hub of evidence-based information to cite, such as cancer.gov. This indicates a resource need that could be of benefit to the pain patient community. (3784) Shifting Paradigms at the Bedside: How to Create, Implement, and Sustain a Holistic Model of Care Teri Verner, DNP, RN, AHN-BC1 1▪▪ Abstract Overview: Integrative therapies are making their way into mainstream hospitals across the country in a variety of ways—some are more successful and sustainable than others. This presentation will illuminate HealthEast’s story of success in creating a holistic standard of care in a health-care system. Using Jean Watson’s Caring Science Theory as the framework for this model, every caregiver is empowered to practice in a truly holistic way. The process begins with self-care opportunities for staff and continues with education and validation of one unit at a time. The foundation of this work is healing presence and other holistic principles, and includes the use of a variety of integrative therapies. Through education and empowering nursing division staff, patients are receiving integrative therapies as a standard of care in all acute care areas of 3 hospitals. This has resulted in shifting the paradigm on how care is delivered at the bedside, as evidenced by chart audits, nurse testimonials and nursing survey results. Rationale: The Joint Commission’s statement on pain assessment and management requires that accredited hospitals require that the hospital offers both pharmacologic and nonpharmacologic approaches for pain control. Additionally, with the opioid crisis, it is incumbent on health-care providers to offer other option s for pain control. The acute care setting is the perfect place to do this. Many hospitals are trying to comply with this with volunteer programs and/or providers paid for with philanthropic dollars offering specific services to patients. While these models do bring therapies to the patients, it is not in a reliable and sustainable way. By teaching bedside staff basic knowledge and skills about healing presence and mind body connection to help facilitate whole person care, as well as offering and teaching integrative therapies, holistic care has become the standard of care in the HealthEast Healthcare System. Objectives: To identify 3 strategies for gaining buy in from staff and articulate 3 key strategies for creating and sustaining an integrative model in a health-care-based setting. (3785) Yoga Therapy: Explanatory and Theoretical Frameworks and Implications for Research, Teaching, and Clinical Practice Steffany Moonaz, PhD1, Marlysa Sullivan, PT, C-IAYT1, Matt Erb, PT2 and Laura Schmazl, PhD3 1Maryland University of Integrative Health, Laurel, Maryland 2Center for Mind-Body Medicine, Tucson, Arizona 3Southern California University of Health Sciences, Whittier, California Abstract Overview: Yoga therapy is a developing and growing complementary and integrative health profession with a growing body of evidence supporting the practice for diverse patient populations and conditions. Some of the limitations to the research in yoga therapy include the heterogeneity of the practices and absence of clear reporting guidelines for yoga protocols. This presentation will present recent developments in the defining and understanding of yoga therapy which may have important implications for both clinical practice and research. The program will explore current work in developing an explanatory framework of yoga therapy informed by philosophical and ethical perspectives including phenomenology, eudaimonia and first person virtue ethics. In addition, the convergence of yoga therapy philosophical principles with current theories in neurophysiology, such as polyvagal theory, to promote self-regulation and resilience will be introduced. The implications for yoga research will be discussed including the difficulties with studying mind-body therapies and how these frameworks may help to create a language and methodology for research. By advocating a common explanatory and theoretical framework it is hoped that this work will contribute to the cultivation of best practices in yoga therapy education, clinical practice, and research. Both an explanatory model and theoretical framework for yoga therapy and the application of these frameworks in diverse patient populations will be presented. Rationale: Mind-body therapies, such as yoga therapy, face obstacles in research as they integrate many top-down and bottom-up processes. These processes are sometimes reduced in the clinical use of therapeutic yoga, and often reduced in yoga research, where the context of the whole of the practice of yoga therapy is lost. Understanding an explanatory framework for yoga therapy as well as the convergence with current neurophysiological principles may assist in the development of research guidelines for yoga therapy and research designs to capture the practice more fully. In addition a common theoretical and explanatory framework may help create best practices in yoga therapy education and clinical practice, all of which will be overviewed. The poster presentation will be built off recent and pending publications in the field of yoga therapy, integrative health and neuroscience. The novel content of this presentation reflects an exciting and rapidly expanding area of integrative health of interest across fields and disciplines. Objectives: To define yoga therapy and the status of its evolution into a distinct integrative health-care profession; to describe an explanatory framework of yoga therapy including the current state of the science; to describe the convergence of yoga therapy philosophical foundations with neurophysiology to address the complex top-down and bottom-up practice of yoga therapy for diverse patient populations including clinical considerations; and to describe and discuss implications for yoga research. (3789) Moving Toward Transprofessional Integration: Findings From an Ethnography of Integrative Pain Management at a Large Urban Pediatric Hospital Isabel Roth, MS, DrPH (c)1, Paula Cuccaro, PhD1, Linda Highfield, PhD1, Joan Engebretson, DrPH1 and Sanghamitra M Misra, MD2 1UTHealth School of Public Health, Houston, Texas 2Baylor College of Medicine, Houston, Texas Abstract Purpose: As we learn more about the detriments of opioids, there is an urgent need to disseminate non-pharmacological pain management strategies. Complementary and integrative medicine (CIM) shows positives clinical benefit with minimal side effects, yet challenges to effective integration in hospital settings remain. While previous qualitative studies have examined the process of integration from the perspective of providers or administrators, there is less understanding of the perspectives of pediatric patients and caregivers regarding integrative pain management. The current study aimed to better understand the process of integration at a large urban pediatric hospital from the perspectives of providers, patients, caregivers, and administrators. Results: Themes identified included logistical challenges navigating between inpatient and outpatient settings, collaboration for complex patients, and the need for a hospital-wide pain strategy. Conclusions: The current study was the first to incorporate the perspectives of pediatric patients, their caregivers, as well as providers and administrators to create a holistic, in depth understanding of the process of integration in a pediatric hospital setting. Despite limitations, these findings further our understanding of the process of developing integrative medicine programs to treat pediatric pain. (3790) The Benefits of Yoga Classes for Veterans With Chronic Lower Back Pain Robert B Saper, MD, MPH1, Marty Boldin1, Ruth Paris, PhD1 and Lisa Koppleman, MSW, MPH1 1Boston University, Boston, Massachusetts Abstract Purpose: Chronic low back pain (cLBP) is the most frequently diagnosed musculoskeletal pain condition among Veterans (Kerns, 2013). Long-term cLBP is associated with non-physical sequelae, such as stress, depression and family problems (IOM, 2011). Initial research on the use of yoga as a complementary and alternative medicine (CAM) approach for cLBP in Veteran populations yields promising results (Groessl et al., 2013). Additionally, findings have shown that yoga classes for cLBP among specialized populations with limited access to CAM, encouraged participation and increased ability to manage non-physical symptoms (Keosaian et al., 2015). Although cLBP is a major problem for Veterans, there is a paucity of qualitative research that explores the non-physical impact of yoga for Veterans with cLBP. Given that healthcare professionals in VA settings often must address the impact of cLBP on their clients, this study explores the ways that yoga classes impact Veterans who seek treatment for cLBP. Results: Findings demonstrate that participation in yoga yielded perceptions of non-physical benefits for Veterans that extended beyond the 12-week classes. They described that breathing and meditative practices taught in classes assisted them in managing stress in an array of real-world settings (eg, driving). Some participants indicated improved focus and ability to manage stressful interpersonal interactions at home and in the workplace. A number of Veterans reported their spouses noticed differences in their ability to respond to and manage stress. Participants identified the importance of being involved in yoga classes designed expressly for Veterans. While most participants indicated that yogic practice was overall beneficial, few continued to practice yoga after the study. In part, this was the case because Veteran-specific yoga classes were not available as a part of VA services. Conclusions: Given the frequent occurrence of cLBP in the Veteran population and the positive non-physical benefits gained through yoga practice by participants in this study, healthcare workers practicing in VA settings may consider Veteran-specific yoga as a means of addressing stress and/or family problems. In addition, further research on the use of yoga for cLBP-related concerns of Veterans is indicated. (3791) Defining the Immune Mediators and Pathways Involved in the Anti-arthritic Activity of Celastrol, a Chinese Herbal Product Brian Astry, PhD1, Rakeshchandra R Meka, MS1, Chun-Tao Che, PhD2, Steven Dudics, BS1, Shivaprasad Venkatesha, PhD3, Kamal D Moudgil, MD, PhD1 and Brian M Berman, MD1 1University of Maryland School of Medicine, Baltimore, Maryland 2College of Pharmacy, University of Illinois, Chicago, Illinois 3Baltimore, Maryland Abstract Purpose: Celastrol, derived from medicinal plants of the Celastraceae family, has anti-inflammatory and anti-oxidant activities. It is a pentacyclic triterpene (C29H38O4) and belongs to a small class of organic compounds called quinone methides. We examined the anti-arthritic activity of celastrol using the rat adjuvant-induced arthritis (AA) model. AA shares several features with human rheumatoid arthritis (RA), an autoimmune disease characterized by chronic inflammation of the synovial lining of the joints, leading to tissue damage and deformities. Results: Celastrol modulated the T-cell proliferative and cytokine (IL-17) responses; the production of chemokines (CCL2, CCL5) and immune cell migration into the joints; the levels of anti-cyclic citrullinated peptide antibodies (aCCP); the balance between pathogenic/protective T cells via STAT3 inhibition; the process of bone remodeling to inhibit osteoclastogenesis; and the inhibition of pro-inflammatory products of fibroblast-like synoviocytes. Furthermore, celastrol altered some of the major cell signaling pathways, including NF-kB pathway, MAPK pathway, JAK/STAT pathway, and RANKL/OPG pathway. Conclusions: Celastrol executes its anti-arthritic activity via altering both cellular and biochemical mediators of immune pathology. The results of our preclinical studies suggest that celastrol is a promising candidate for further testing in the clinic for RA. If successful, celastrol can fill a vital gap in the treatment of RA, wherein despite the availability of many potent mainstream drugs, there are many patients who either fail to respond to these drugs or are seeking alternative treatments owing to significant toxicity of these drugs following prolonged use. (3793) Salutogenesis and the Greco-Arabic (Unani) Medicine Roots of Health Promotion Hakima Amri, PhD Washington, DC Abstract Overview: While the biomedical community in the West does not necessarily identify with ancient medical concepts, it is important to note that the teachings of Hippocrates (460–370 BC) and Avicenna or Ibn Sina (980–1037 CE) have emphasized the creation of health and the preservation of wellness in their respective Corpus of Medicine and Cannon of Medicine. Those two aspects of medicine are currently at the center of the 21st century modern medicine and are described as salutogenesis. Salutogenesis or the creation/preservation of health is the crux of Greco-Arabic (Unani) Medicine. It stems from the ancient practice of Healthy Bodies Management that is presented in a 6-step framework. Those are summarized as follows: (1) breathe fresh clean air: modern science has shown not only the obvious importance of oxygen but also the detrimental effects of ischemia; (2) eat nutritious food and drink: this is witnessed in today’s debate about diets as well as the importance of seasonal and whole foods; (3) alternate between movement and rest: this is becoming the modern physician’s recommendation to manage most chronic diseases; (4) respect sleep and wakefulness cycles: it is only recently that the science of chronobiology emerged; (5) ensure regular eating and bowel movement: irritable bowel disorders are devastating and are still with unknown etiology; and (6) maintain healthy mental state: Mind-Body Medicine is now being incorporated in various aspects of medicine. In this work, we explain the Science of Health Preservation described by Avicenna more than a millennial ago within the current Salutogenic theoretical framework. It is important to revisit these ancient medical systems in light of modern science and discovery. Rationale: This topic is important as it shows how the alternative medical systems are being revisited to inform our modern medicine on various aspects of health preservation and wellness promotion. Objectives: Participants will: 1. Learn about Unani Medicine as a complete alternative medical system of the Mediterranean, Middle Eastern, and Persian regions; 2. Find how health preservation and wellness promotion have been the pillars of Unani Medicine; and 3. Explain the 6 prerequisites of health from Unani Medicine in the salutogenesis framework of modern medicine. (3794) A Virtual Resiliency Treatment for Parents of Children With Learning and Attentional Disabilities: A Randomized Pilot Trial Jacqueline Proszynski, BS1, Giselle K Perez-Lougee, PhD1, Rachel A Millstein, PhD1, Lara N Traeger, PhD1, Emma Chad-Friedman, BA1, Karen A Kuhlthau, PhD1, Christina M Luberto, PhD2 and Elyse R Park, PhD, MPH1 1Massachusetts General Hospital, Boston, Massachusetts 2Boston, Massachusetts Abstract Purpose: One in 5 children have a learning or attentional disability (LAD). Parents of children with LAD are vulnerable to high levels of distress. Despite their vulnerability, evidence-based resiliency treatments for parents of children with LAD have not been developed. Results: Fifty-six parents (mean age = 46.8; SD = 5.7; 89% female, 88% white, non-Hispanic; 75.9% married/partnered; 50% employed) participated. 70.4% of participants completed ≥6 sessions. Among 62% of intervention participants who completed the T2 survey, 81% reported practicing relaxation response exercises daily/weekly, and 76.2% rated ≥7 (1, not at all – 9, very) on the treatment reducing stress-related symptoms. T1-T2 comparisons found that intervention vs control participants showed significant improvements in distress (ΔM = −1.48; CI = −2.95, –.002; P = .05), CES (ΔM = 6.52; CI = 1.37, 11.68; P = .01), CAMS-R (ΔM = 3.24; CI = .77, 5.71; P = .01), and MOCS-A (ΔM = 7.48; CI = 3.45, 11.50; P = .001), but not in social support. Among intervention participants, T1-T2 improvements were reported on distress, the CES, CAMS-R, and MOCS-A (all Ps ≤ .05). Conclusions: Pilot trial findings showed promising feasibility, acceptability, and efficacy. Specifically, we demonstrated that a virtually delivered resiliency treatment improved parents’ overall levels of distress, stress coping, and resiliency. The virtual delivery modality facilitates its implementation and dissemination. Funding: Marino Foundation. (3795) Diet and Psychosis: A Scoping Review Monique Aucoin1 and Laura LaChance, MD 1Toronto, ON, Canada Abstract Purpose: Psychotic disorders, including schizophrenia, affect approximately 1% of the population. Despite the use of the best available pharmacologic and behavioral interventions, patients suffer from a dramatic 20-year reduction in life expectancy. Despite the new field of nutritional psychiatry research, no comprehensive assessment and synthesis of the research related to diet and psychosis has been completed. This review seeks to scope and map the range of therapeutic strategies and mechanisms being pursued through the completion of a systematically completed, scoping review. Results: The search strategy yielded 50 000 results; 45 000 have been screened to date with 1200 studies identified. Preliminary analysis reveals studies that involve primarily human subjects, an equal portion of experimental and observational studies, and common nutrients of interest including amino acids, vitamins, fats, and whole diet approaches. Commonly cited mechanisms include oxidative stress, inflammation, and allergy. Conclusions: Although in preliminary stages, relative to other medical conditions, there is research related to the impact of dietary factors on psychotic disorders, next steps include synthesis and analysis of the identified studies as well as framework creation, analysis of gaps, and opportunities. Application of these results will include development of an evidence-informed diet strategy for use in a pilot clinical trial and tool kits to assist clinicians and patients with applying diet interventions for the improvement of mental health. (3796) Lessons Learned: Implementation of Longitudinal Studies Green Exercise Hollyn M Cetrone1, Arseniy Minasov1, William R Leonard, PhD1, Mark A Pereira, PhD2, Junia Nogueira De Brito, MPH2, Ingrid S Schneider, PhD2, Teresa H Horton, PhD1, Annie J Lee1 and Elizabeth PD Koselka, BA1 1Northwestern University, Evanston, Illinois 2University of Minnesota, St. Paul, Minnesota Abstract Purpose: Exercising in natural landscapes, green exercise, is hypothesized to reduce stress and lead to better health outcomes than exercising in a built environment. However, for green exercise to be accepted as a complementary therapy by the wider medical community, additional research is needed to identify the biomedical mechanisms, duration, and frequency of exposures required to improve health outcomes. To obtain these data, longitudinal studies using rigorous controls are needed. We report the lessons learned from implementing two longitudinal, randomized, cross-over study designs. Results: Sharing methods and problem solving between study teams facilitated progress. Recruiting and retaining participants for a longitudinal study requiring repeated laboratory visits required flexibility from the investigators and ample compensation for the participants. Males were less willing to participate than females, necessitating targeted recruitment materials. Automated reminders facilitated compliance. Relational database software facilitates the integration of multiple forms of data. Conclusions: Collaborative studies using harmonized assessments can facilitate the longitudinal studies needed to inform the evidence base for green exercise. (3802) Lost and Found: Musical Reminiscence Therapy for Dementia Care Nils P de Mol van Otterloo, MSW1 1South Pasadena, California Abstract Overview: Dementia affects millions of patients and patients' families. Finding clinical solutions that are both effective and economical for clients is important. Musical reminiscence therapy (MRT) is the use of customized music to improve the lifestyle of persons living with dementia and their family members. It is possible with MRT for dementia patients to experience emotional improvement by sharing music that was familiar to them in their youth. The economic and educational barrier to MRT is very limited. It has been demonstrated that persons in countries with very little health infrastructure can benefit from this type of therapy. It is possible to teach nurses, social workers, music therapists, and patients’ family members how to do MRT in as little as one lesson. Making clinical tools available that are cost effective and beneficial to the cohort of clients and families is a goal for the future of dementia care. MRT is a fusion of practical technology and integrative health innovation. Rationale: MRT is based on neurological principles that are universal, making this clinical tool effective globally. Use of music to help dementia patients has been demonstrated to be effective. MRT provides a clinical model for therapeutic care of dementia patients and their families. MRT provides the link between music, neurologic principles, and technology in order to provide a fast and effective method for disseminating care to dementia patients of diverse backgrounds. Objectives: This session will demonstrate the clinical use of MRT. Attendees will learn how technology is making it possible to change the lives of dementia patients and their families. By the end of this session, attendees will be able to explore MRT and share its use with clinicians, students, and clients. (3806) Integrating a Mind-Body Medical Group Visit for Chronic Pain Patients Into Routine Primary Care Paula Gardiner, MD, MPH1, Salvatore D'Amico, BS1, Iniya Rajendran, MD1 and Manasi Bhandarkar, MD1 1Boston, Massachusetts Abstract Purpose: The number of low income and racially diverse chronic pain patients and the consequent use of opioids have risen significantly over the past decade. As a result, medical group visits that offer mindfulness based non-pharmacological and self-care approaches have received attention. Results: Eleven patients, 9 females and 2 males, were scheduled for the group visit. The average attendance was 6 participants each week with 7 participants attending sessions. Seventy-one percent of patients identified as either Black or Hispanic. All patients had a diagnosis of musculoskeletal chronic pain with an average PROMIS pain interference score that was 1.8 SD higher than the U.S. population. On the 11-point pain scale, the average score change from baseline to 6 weeks was 7.2 to 6.0. The drop in average blood pressure drop was from 134/86 to 122/79. Patients reported trying new supplements such as fish oil, turmeric, magnesium, vitamin D and attending osteopathic, acupuncture, nutritionist referrals. Transportation issues, timing of the group and receiving prior insurance authorization were challenges observed. Participant feedback included (1) usefulness of learning Mind-Body techniques for both pain control and overall health and (2) need for more group visits. Conclusions: Group medical visits that integrate Mind-Body techniques have a role in the management of chronic pain. It is well accepted by the urban and racially diverse population and has the potential to be fully integrated into routine primary care. (3812) Genetic Risk Testing and Integrative Health Coaching for CHD and T2D Prevention: An RCT to Improve Health Behaviors in the Air Force Vlayka Liotcheva, PhD1, Gladwell Mbochi, BS1, Allison A Vorderstrasse, DNSc2, Michael Musty, BA1, Teji Rakhra-Burris, MS3, Carlos J Maldonado, PhD4, Geoffrey S Ginsburg, MD, PhD1, W Michael Scott, DNP, FAANP5, Nicole H Armitage, Qing Colonel, USAF, PhD6, Jianhong Yang, PhD7, Ruth Q Chang, PhD7 and Wolever, PhD7 1Durham, North Carolina 2NYU Rory Meyers College of Nursing, New York, New York 3Duke University, Durham, North Carolina 4US Veterans Administration, Orlando, Florida 5Texas Tech University Health Sciences Center, El Paso, Texas 6U.S. Air Force School of Aerospace Medicine, Wright-Patterson Air Force Base, Ohio 7Nashville, Tennessee Abstract Purpose: Innovative approaches are needed to motivate and support health behaviors to reduce risk of coronary heart disease (CHD) and type 2 diabetes (T2D). Combining integrative health coaching (IHC) with risk counseling that provides novel genetic information may have additive or interactive effects. We examined the effectiveness of providing participants in AF primary care with 5 months of IHC following risk counseling (standard ± genetic risk) in improving exercise and dietary intake at 12 months. Results: A logistic regression model for exercise (categorized into 2 levels) at 12 months, adjusting for baseline, revealed that those who received IHC were 2.85 times more likely to report moderate, hard, or very hard intensity activity versus inactivity or light activity. No differences were seen in those who received genetic risk testing versus those who did not. Linear mixed models for dietary intake demonstrated no significant differences at 12 months for IHC or genetic risk testing groups. Mediation analyses will also be discussed, including the finding that IHC produced greater weight loss in those with higher genetic risk for CHD. Conclusions: While few significant differences emerged in outcomes by genetic risk levels, the IHC groups reported significant improvements in physical activity, relevant stages of change, and depression symptoms, providing support for IHC as an intervention to lower risk for CHD and T2D, and particularly for those in higher genetic risk groups. (3814) Health and Wellness Coach Collaboration With Psychiatrist in Multimodal Intervention for ADHD: Case Report Elizabeth Ahmann, ScD, Rn, PCC1, Katherine Smith, MPH, CHWC1, Laurie Ellington1 and Rebecca O Pille, PhD, CWP1 1Maryland University of Integrative Health, Laurel, Maryland Abstract Purpose: Stimulant medications are the most common treatment for attention deficit hyperactivity disorder (ADHD). However, a multimodal approach including health and wellness coaching (HWC) yielded improved outcomes for a young adult female struggling with graduate studies. The purpose of this case report is to illustrate the value of combining HWC, a science-based, client-centered behavioral intervention, with psychiatric care in realizing improved ADHD management. Results: Six weeks of HWC resulted in meaningful improvements for the client, in areas including academic achievement, personal growth, self-efficacy, daily functioning, organizational skills, interpersonal skills, and self-care. At the end of 6 weeks, the psychiatrist submitted a letter outlining these improvements to the client’s academic program, and the client was allowed to resume her graduate studies. This was the most important outcome from the client’s point of view. Follow-up conversations between the coach and client indicated that she maintained her gains over time. Conclusions: Collaboration between a psychiatrist, health and wellness coach, and client resulted in a successful intervention for improved management of the client’s ADHD and executive functioning challenges. These changes contributed to the client meeting her goal of being permitted to resume her graduate studies. (3815) Evidence for the Effectiveness of ADHD Coaching Elizabeth Ahmann, ScD, Rn, PCC1, Micah Saviet, BA, CNA and Lisa Joy Tuttle, MA, BCC2 1Maryland University of Integrative Health, Laurel, Maryland 2Philadelphia, Pennsylvania Abstract Overview: Coaching for attention-deficit/hyperactivity disorder (ADHD) emerged as a treatment modality in the 1990s but receives less attention than either psychopharmacological or psychotherapeutic interventions in the management of ADHD. Over the past decade, a research base examining coaching for ADHD has begun to develop. This poster, reviewing extant research on ADHD coaching, summarizes outcomes of this emerging practice modality. Most studies in this review were identified through PubMed/Medline, EBSCO Megafile, Google Scholar, and ERIC databases using keywords “ADHD,” “executive functions,” and “coaching.” Several studies were identified through cross-referencing citations in articles and a generic Google search. Nineteen studies addressing ADHD coaching outcomes were identified. Of these, 16 were published in peer-reviewed journals. A study in a book, a dissertation, and a conference presentation were also found. The 19 studies varied in design, from a case study to randomized controlled trials, and included qualitative and quantitative approaches. Studies were mostly small in size—10 studies had ns ≤ 10—and examined coaching for ages from childhood through adulthood. Outcome measures varied: among the 19 studies, participants demonstrated improvements in executive functioning and ADHD symptoms (19), well-being/improved family life (8), and self-efficacy/self-esteem (3). Three studies found maintenance of gains; 9 identified satisfaction with coaching. Heterogeneity in study design, varied training of the coaches, and varied outcome measures complicate comparison of results between studies; small sample sizes are a limitation in this body of research. Despite limitations, extant research consistently demonstrates beneficial client outcomes with ADHD coaching. Rationale: An overview of extant research on outcomes of ADHD coaching will assist integrative health practitioners in understanding the evidence for, and value of, collaborating with coaches in effective client-centered management of ADHD. Objectives: Awareness and understanding of extant ADHD coaching research, participants will appreciate that coaching appears effective both as a stand-alone modality and as a useful aspect of multimodal integrative client-centered treatment for ADHD. (3816) Tai Chi and Wellness for Gulf War Illness: Protocol for a Randomized Trial Katharine Smidt, PhD1, DeAnna L Mori, PhD2, Anica Pless Kaiser, PhD1, Elizabeth Weinstein, BA1, Barbara L Niles, PhD1 and Chenchen Wang, MD, MSc3 1National Center for PTSD – Behavioral Science Division, Boston, Massachusetts 2Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts 3Tufts Medical Center, Boston, Massachusetts Abstract Purpose: Over 40,000 Veterans who served in the 1991 Gulf War have a form of chronic multisymptom illness that defines Gulf War Illness (GWI). With no existing proven treatments, it is critical to find efficacious and acceptable treatments for GWI. Tai Chi has been practiced for centuries and accumulating evidence demonstrates that it promotes both physical and psychological well-being. Our randomized trial is underway to establish the efficacy of a Tai Chi as a treatment for GWI. The current paper presents lessons learned in developing and implementing the protocol for this rigorous, large-scale randomized clinical trial. Results: We will present our study design and describe how we addressed issues such as: development of manualized interventions, minimizing participant disappointment regarding randomization to group, finding space for group interventions, minimizing waiting for a full cohort of participants to randomize, maximizing session attendance, ensuring availability of instructors, maximizing participant recruitment, and keeping assessors blinded to treatment condition. Conclusions: There are many challenges inherent in conducting randomized clinical trials for mind-body treatments. We offer the solutions we found to address obstacles to scientific rigor in the design and implementation of a large-scale trial. (3817) Outcomes of an Online Interprofessional Integrative Health Course for Primary Care Educational Programs and Clinics Audrey J Brooks, PhD1, Benjamin Kligler, MD, MPH1, Victoria Maizes, MD1 and Patricia Lebensohn, MD1 1Tucson, Arizona Abstract Purpose: Clinical and cost-effectiveness evidence for integrative healthcare (IH) is accruing; however, a shortage of trained IH providers exists. The National Center for Integrative Primary Healthcare developed a course to address this need with the goal of transforming primary care education to include an interprofessional IH approach to patient care. Results: In sum, 679 completed the course. Medical knowledge and IH self-assessment scores improved at posttest (P < .05). Units were highly rated (5-point scale): met objectives (4.4), technology (4.2), clinical utility (4.1), educational depth (3.7), and helpfulness of resources (3.8), reflections (3.8), and sharing reflections (3.2). A majority (60–73%) recommended incorporating the units into required training. Final survey ratings were also positive: interest in applying IH (4.5), seek additional IH education (4.3), course enhanced educational/clinical experience (4.3), and recommend to others (4.2). Two thirds reported incorporating new self-care practices. Improvements in interprofessional collaboration, empathy, self-care behaviors, resiliency, and well-being (P < .004) were found. Conclusions: The Foundation Integrative Healthcare (FIH) course successfully provided IH training to health professionals across the primary care spectrum. FIH provides a foundation for building an IH training program in educational and clinical settings. Online courses address time, cost, and curriculum consistency challenges and can be widely disseminated. (3820) A Study on the Severity Classification in the Korean Diagnosis-related Groups for Korean Medicine Byungmook Lim, PhD1, Jiseon Ryu, KMD, PhD1, Dongsu Kim, KMD, PhD2 and Byungwook Lee, KMD, PhD3 1Pusan National University, Yangsan/Gyeongnam, Republic of Korea 2Korea Institute of Oriental Medicine, Daejeon, Republic of Korea 3Dongguk University, Gyeongju, Republic of Korea Abstract Purpose: Patient Classification System for Korean Medicine inpatients (KDRG-KM) was developed in 2013 and has been applied for monitoring the quality and costs of Korean Medicine hospitals. Yet, severity of patients’ condition is not applied in the KDRG-KM. This study aimed to develop the severity classification methods for KDRG-KM and assessed the explanation powers of the severity adjusted KDRG-KM. Results: Two options for severity classification were deduced based on the severity classification principle in the domestic and foreign DRG systems. The option 1 is to classify severity groups using Clinical Complexity Level (CCL) and Patient CCL scores, and the option 2 is to form a severity group with patients who belonged principal diagnosis-secondary diagnosis combinations which prolonged length of stay. For third option, patients who received certain treatments for severe conditions were grouped into severity group. The treatment expense of the severity group was significantly higher than that of other patients groups. Conclusions: Applying the severity classifications using principal diagnosis and secondary diagnoses can advance the KDRG-KM for Korean Medicine hospitalization. More practically, including patients with procedures for severe conditions in a severity group needs to be considered. (3821) A Targeted Non-pharmacologic Intervention to Prevent Chronic Low Back Pain in High-risk Patients—The TARGET Trial Rebecca Mishuris, MD1, Charles Williams, MD1, Samia Jaffar, MPH1, Dorothy N Plumb, MA1, Robert B Saper, MD, MPH1 and Iniya Rajendran, MD1 1Boston, Massachusetts Abstract Purpose: Acute Low Back Pain (aLBP) may progress to persistent chronic low back pain (cLBP) with poor clinical outcomes. Early risk factor screening can potentially guide primary care clinicians to intervene with high-risk aLBP patients to prevent progression to cLBP. Psychologically Informed Physical Therapy (PIPT), utilizing biomedical and cognitive behavioral approaches, is a potential intervention to prevent cLBP progression and warrants further evaluation. Results: To date, in Boston, 1081 patients have been screened. Six hundred thirty-seven (59%) have cLBP and were ineligible for TARGET but were provided nonpharmacologic pain management resources. Of the 444 (35%) with aLBP, 165 (37%) were high risk and have been referred to PIPT. Conclusions: It is feasible to integrate aLBP risk stratification within the EMR in underserved primary care settings using a patient navigator model leading to non-pharmacological pain management referrals. Challenges in risk stratification include cross-cultural differences and language nuances among our diverse population. (3823) Needs and Capacity Assessment for Research on Naturopathy in Canada Kieran Cooley, ND1, Christopher Knee, MSc, ND2, Diane Grondin, PhD3, Teresa Tsui, ND, MSc3 and Monique Aucoin3 1Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada 2Ottawa Hospital Research Institute, Ottawa, Ontario, Canada 3Toronto, Ontario, Canada Abstract Purpose/Background: Naturopathy has been depicted as both an emerging and evolving profession in Canada. Despite recent shifts in regulation and recognition of the role that naturopathy plays in health-care delivery in Canada, comparatively little research has been conducted on this practitioner group. In order to better understand the needs and capacity for research on naturopathy, a survey of naturopaths, naturopathic associations, and complementary/alternative medicine researchers was piloted, revised through stakeholder engagement, and broadly disseminated. Results: Pilot testing, stakeholder engagement, and analysis of a facilitated workshop have informed the design and distribution of a web-based needs and capacity assessment for research on naturopathy in Canada. Results of the full survey will be available for presentation prior to the ICIMH conference. Conclusions: Findings from this investigation will be used to inform an agenda for naturopathy research and activities of the N-SIG with respect to enhancing research capacity, improving the use of evidence within and about the naturopathic profession. (3824) Is Fasting Safe? A Chart Review of Adverse Events During Medically Supervised, Water-only Fasting Alan C Goldhamer, DC1, Toshia R Myers, PhD1, Bradley C Saul, DrPH2 and John S Finnell, ND, MPH, Lac3 1TrueNorth Health Foundation, Santa Rosa, California 2North Carolina State University, Chapel Hill, North Carolina 3Bastyr University Research Institute, Austin, Texas Abstract Purpose: Evidence suggests that fasting, during which only water is consumed, results in potentially health promoting physiological effects. However, peer-reviewed research assessing the safety of water-only fasting is lacking. To address this, we conducted a chart review to describe adverse events (AEs) that occurred during medically supervised, water-only fasting. Results: There was 80.5% agreement between the original and secondary MedDRA codes, with a weighted kappa statistic (squared weights) of 0.92 measuring agreement of the AE grade. During the protocol period, the highest grade AE (HGAE) in 555 visits was a grade 2 event or lower, in 212 visits it was a grade 3 event, in 1 visit it was a grade 4 event, and there were no grade 5 events. There were 2 (0.002%) visits with a serious AE (SAE). The majority of AEs identified were mild (n = 4490, 75%) in nature and known reactions to fasting. Conclusions: To our knowledge, this is the most comprehensive analysis of AEs experienced during medically supervised, water-only fasting conducted to date. Overall, our data indicate that the majority of AEs experienced were mild to moderate and known reactions to fasting. This suggests that the protocol used in this study can be safely implemented in a medical setting with minimal risk of a SAE. (3826) Far Infrared Decreases Thermal Hypersensitivity, Edema Formation, and Nitrite/Nitrate Plantar Tissue Concentration in a Mouse Model of Paw Inflammation Ralph F Rosas, MsC1, Aline A Emer, MsC1, Ana P Batisti, MsC1, Bruna T Lenfers, MsC1, Franciane Bobinski, PhD1, Fabricia Petronilho, PhD1, Lucinéia G Danielski, MsC1, Mariana P Goldim, MsC1 and Francisco Cidral-Filho, PhD2 1University of Southern Santa Catarina, Florianopolis, Palhoça, Brazil 2University of Southern Santa Catarina, Palhoça, Brazil Abstract Purpose: To evaluate the possible effect of far infrared (FIR) emitted by far-infrared emitting ceramic (cFIR) materials upon thermal hypersensitivity, edema formation, and nitrite/nitrate plantar tissue concentration in the mouse model of Freud’s complete adjuvant (CFA)-induced paw inflammation. Results: CFA-injection resulted in a significant decrease in the response latency to heat stimulus (hot plate test), an increase in paw edema as well as increase in nitrite/nitrate plantar tissue concentrations. cFIR treatment induced a significant decrease in sensitivity to hot stimulus (P < .05); significant antiedematogenic activity (P < .05), as well as a significant decrease in the nitrite/nitrate concentration (P < .05). Conclusions: FIR emitted by cFIR decreased thermal hypersensitivity, edema formation, and nitrite/nitrate plantar tissue concentration in a mouse model of CFA-induced inflammation. (3827) Randomized Placebo-controlled Trial of Acupuncture to Prevent Radiation-induced Xerostomia Lorenzo Cohen, PhD1, Qi Wei, MS1, Zhiqiang Meng, MD2, Wenying Bei, BS eq2, Yehua Shen, MD2, Mark Chambers, DMD1, Chaosu Hu, MD2, Caijun Wu, BS eq2, David I Rosenthal, MD1 and M Kay Garcia, DrPH1 1Houston, Texas 2Fudan University Cancer Center, Shanghai, China Abstract Purpose: To determine if acupuncture can prevent radiation-induced xerostomia among head/neck cancer patients undergoing radiotherapy (XRT) in China and the United States. Results: For combined institutions at the 1-year follow-up (N = 358), there was a significant between-group difference between VA and WLC (26.6 vs 34.8, P = .001; Cohen’s D = −0.44), with marginal between-group difference between VA and SA (26.6 vs 31.3, P = 0.06; D = −0.26) and no difference between SA and WLC. There was a significant group by institution effect. For patients in China (N = 221), there were significant group differences between VA and WLC (20.8 vs 29.6, P = .005; D = −0.48) and between VA and SA (20.8 vs 29.9, P = 0.0045; D = −0.50), with no difference between SA and WLC. For patients in the United States (N = 137), there were significant between-group differences between SA and WLC (31.8 vs 42.2, P = .01; D = −0.59) and marginal group difference between VA and WLC (34.7 vs 42.2, P = 0.07; D = −0.42), with no differences between VA and SA. Incidence of clinically significant xerostomia followed a similar pattern. Center differences will be discussed as they relate to culture and the neuroscience of placebo. Conclusions: Patients in China who received VA concurrently with XRT experienced significantly less xerostomia as compared to SA and standard oral hygiene only. In the United States, both VA and SA reduced xerostomia symptoms 1-year after XRT. (3830) Treating Urge Urinary Incontinence in Older Adult Women with Complementary Therapies: A Feasibility and Randomized Controlled Trial Utilizing MBSR and HEP Katherine P Supiano, PhD, LCSW, FT1 and Katarina Friberg Felsted, MS2 1University of Utah College of Nursing, Salt Lake City, Utah 2Salt Lake City, Utah Abstract Purpose: Older adult women have the highest incidence of urge urinary incontinence in the population. Current treatment practices for this age-group remain insufficient and largely ineffective. This study sought to determine the research and intervention feasibility of a randomized controlled trial comparing mindfulness-based stress reduction compared with the Health Enhancement program in older adult women presenting with urge urinary incontinence. Preliminary efficacy data were also evaluated. Results: Feasibility determinants were recorded and evaluated throughout and at completion of the study. All 6 feasibility determinants provided positive results in the enrolled population. Preliminary efficacy data indicate that while both mindfulness-based stress reduction (MBSR) and HEP groups improved in a statistically significant way, the MBSR group improvement was statistically significant compared to the HEP group improvement. Additional mixed method data analysis is underway. Conclusions: These positive feasibility results warrant the design of a larger scale, multisite trail to study the efficacy of MBSR in treating urge urinary incontinence. The feasibility and preliminary efficacy data suggest that MBSR may be a reasonable approach for older adult women with urge urinary incontinence. There is also evidence that a combined MBSR and HEP approach may be suitable. (3836) The Role of the ECB System in the Effects Induced by High-intensity Swimming Exercise in an Animal Model of Chronic Peripheral Inflammation Francisco Cidral-Filho, PhD1, Afonso Salgado, PhD1, Daniel F Martins, PhD1, Aline Siteneski2, Daniela D Ludtke2 and Adair RS Santos, PhD2 1University of Southern Santa Catarina, Palhoça, Brazil 2University of Federal of Santa Catarina, Florianópolis, Brazil Abstract Purpose: The present study investigated the role of the ECB system in the effects induced by high intensity swimming in an animal model of chronic peripheral inflammation. Results: High-intensity swimming induced hyponociception and reduced paw edema. AM281 or AM630 pretreatment prevented swimming-induced hyponociception. Preadministration of URB937 or JZL184 prolonged swimming-induced hyponociception. Conclusions: High-intensity swimming induces hyponociception and reduces edema in animals with chronic peripheral inflammation. Activation of CB1 and CB2 receptors and prolongation of hyponociception by inhibition of ECB degradation enzymes confirm the participation of the ECB system in swimming-induced hyponociception. (3837) PACT—A Transformative Self-management Program for Chronic Pain Utilizing Online Education and Tele-health Coaching Jeanette Ziegenfuss, PhD1, Gabriela Vazquez Benitez, PhD1, Karen Lawson, MD2, Robin Whitebird, MSW, PhD2, Elizabeth Grossman, MS3 and James R Fricton, DDS, MS3 1Health Partners Institute, Bloomington, Minnesota 2Bloomington, Minnesota 3Health Partners Institute, Edina, Minnesota Abstract Purpose: The Institute of Medicine has made research on pain conditions among its highest priorities due to high prevalence and cost. Health professionals’ primary role for chronic pain should be guiding, coaching, and assisting patients with day-to-day self-management. However, they often lack the time and training to perform this role, and there is limited research on self-management approaches. This transformative care model integrates robust self-management online training with health and wellness tele-coaching to improve outcomes from self-management of chronic pain. Results: Eighty-one subjects were randomized to PACT and TSC, 1 subject withdraw from the study. Mean age was 47 (SD = 16), 86% were female, and 82% had pain onset of 1 year or more. Participants showed significant improvement in measures of pre–post change at 8 weeks for pain severity (PACT −.94 vs TSC −0.5), but not for pain interference or jaw functioning (16 week follow-up data are still in collection at the time of this submission but will be completed and included at the time of the conference). Conclusions: This research demonstrated that transformative care model that includes tele-health coaching and online training is both feasible and effective. It provides an accessible, scalable, and transferable method for self-management that can be integrated into routine care without increasing the burden of time demands upon the providers. (3839) A Randomized Trial Comparing a Stretching/Exercise Program and Learning About Self-care Practices From a Self-care Book for Chronic Low Back Pain Marc Brodsky, MD1, Ann Hansen, DVM, MD, FACP1 and Wendy Bjerke, PhD2 1Boise, Idaho 2Idaho Abstract Purpose: To evaluate the efficacy of a stretching exercise program versus learning self-care practices from a self-care book for chronic low back pain Results: This is a late breaking abstract as the final cohort began 10/4/17 and will be completed 12/20/17. Conclusions: This is a late breaking abstract as the final cohort began 10/4/17 and will be completed 12/20/17. (3841) Challenges and Strategies for Implementing Battlefield Acupuncture in the VA Karleen Giannitrapani, PhD, MPH1, Stephanie Taylor, PhD, MPH2, Princess Ackland, PhD3, Jesse Holliday, MSW1, Kavitha Reddy, MD4 and Benjamin Kligler, MD, MPH4 1VA Palo Alto Healthcare System, Menlo Park, California 2VA Greater Los Angeles Healthcare System, Los Angeles, California 3Minneapolis VA Health Care System, Minneapolis, Minnesota 4Washington, DC Abstract Purpose: Battlefield acupuncture (BFA) is a rapid, 5-needle, auriculotherapy protocol for pain. Although nearly 1000 VA clinicians have been trained in BFA, little is known about how well BFA has been implemented at the VA. We sought to understand the challenges BFA providers experienced in implementing BFA and any successful strategies they used to overcome these challenges. Results: Sites reported multiple implementation challenges. Many said their states’ licensure regulations prevent nonphysician providers from having acupuncture privileges. Others reported having insufficient dedicated time to meet high patient demand (e.g., having a BFA-specific clinic timeslot). Perhaps unique to the VA were challenges in being able to purchase supplies and often having an overly burdensome local credentialing process. Many said that several months had passed between the time they were trained in BFA and could finally overcome these barriers to provide BFA, resulting in their no longer feeling confident they knew how to deliver BFA. Strategies used to overcome implementation challenges included integrating BFA provision in an existing clinic (e.g., pain or mental health clinic); using group visits and walk-in clinics to meet high patient demand; increasing buy-in from peers, administrators and leadership to overcome logistical and local credentialing challenges; getting BFA training only after credentialing challenges were addressed; and having a dedicated person for either scheduling or providing BFA. Conclusions: Systematic challenges can impede BFA implementation at the VA and perhaps elsewhere. Some challenges can be addressed at local facilities, while others are regulatory in nature and, as such, are more impeding. (3845) Human Touch: Perceptions of Self-efficacy From a Non-pharmacology Treatment for Individuals Living With HIV/AIDS Carolee Dodge-Francis, EdD1, Sheila Clark, PhD1, Karl Kingsley, PhD, MPH1 and Anne E Weisman, PhD, MPH, LMT1 1University of Nevada Las Vegas, Las Vegas, Nevada Abstract Overview: HIV/AIDS and a subsequent drug regimen can create many negative symptoms and side effects that lead those infected to seek out alternative and complementary therapies as treatments. Massage therapy is an ancient form of treatment that is now gaining popularity as part of the integrative medicine movement. A phenomenological, qualitative research study was conducted at Aid for AIDS of Nevada. Participants received a massage, and rich descriptive narratives were captured from the 12 participants: 6 females and 6 males, ranging in age from 30 to 67 years. The interviews were transcribed and coded for themes. For the purpose of this qualitative study, the research design included field observations and one on one interviews. Data were analyzed using a phenomenological lens. The data were coded for themes that emerged from the data and grouped. Four thematic themes resulted from this data analysis: self-efficacy, human connectivity through touch, physical and mental responses, and an emotional roller coaster. Bandura states “perceived self-efficacy is concerned with people’s beliefs in their ability to influence events that influence their lives.” Many of the participants expressed statements that the nonpharmacology treatment of massage therapy assisted them in making a variety of positive decisions, thus alluding to the question of self-efficacy. Rationale: People living with HIV/AIDS face many challenges managing the multiple symptoms that accompany infection. In a clinical trial study among HIV-positive patients seeking relief from complementary and alternative therapies, the most commonly reported symptoms were nausea, insomnia, dermatological problems, depression, and weakness. To date, much of the research about living with HIV/AIDS focused on prevention and treatment, symptom management, and quality of life. There has been a surge in massage therapy research recently. However, no research exists to examine how receiving massage therapy could impact self-efficacy for people living with HIV/AIDS. Finch and Becker, in preliminary work investigating changes in self-efficacy in MS patients receiving massage therapy, found significant improvement after an 8 week series of treatments. Self-efficacy has been found to be a predictor of health status, and the concept is implicitly linked to psychoemotional morbidity. Notably, a negative perception of control (a key component of self-efficacy) has been associated with both decreased optimism and increased hopelessness. These findings suggest that massage therapy has the potential to positively impact people with HIV/AIDS who receive massage therapy and will explore how self-efficacy is impacted. This directly ties into the theme of the conference of Collaboration in Action: Advancing Integrative Health through Research, Education, Clinical Practice and Policy. Objectives: Participants will know how massage therapy affects self-efficacy for individuals living with HIV/AIDS. (3846) The Effect of Mindfulness Practice on Graduate Occupational Therapy Students Perceived Stress and Well-being Mary Walsh Roche, MS1, Nicole Palse1, Alexander Lopes1, Sarah Wolosin1, Ingrid Nichols1, Christine Rigney1 and Jan Garbarini, PhD1 1Dominican College, Orangeburg, New York Abstract Overview: The purpose of this study is to identify the effects of mindfulness practice on reducing perceived stress levels among occupational therapy students enrolled in a nontraditional weekend graduate program who are beginning the clinical phase of their education. The idea for a program in which participants could practice on their own as part of a virtual community was proposed as a way to increase opportunities for students to learn about and experience mindfulness practice. As part of this initiative, mindfulness education and practice sessions were incorporated into the Fieldwork Seminar graduate course classroom activities. All students enrolled in the course attended a 1-h “Introduction to Mindfulness” presentation and engaged in three 15-min mindfulness practice sessions over the course of the 6 weekends they were on campus during the Fall trimester (16 weeks). In addition, students were invited to volunteer to participate in an independent mindfulness practice component as part of a virtual community. Eighteen of 43 students agreed to participate in this virtual community and independent practice. These participants were provided with a brief-guided mindful breathing and body scan audio recording to practice daily on their own for 10 weeks. Participants received weekly email practice reminders and resources, and they agreed to chart the frequency of their practice. All students completed quantitative and qualitative pre- and posttest self-report measures of perceived stress and mindfulness. Students were also asked to respond to open-ended questions exploring their perceptions and knowledge base at pre- and posttest. Results were analyzed to assess the change that occurred over the course of the program. Future occupational therapy practitioners benefit from learning about mindfulness and such programs may assist students in developing practices early in their careers that promote well-being and stress relief. Rationale: The topic is relevant to the conference theme of “Collaboration in Action: Advancing Integrative Health through Research, Education, Clinical Practice and Policy” as this poster presentation addresses education, research, and clinical practice. The purpose of the study is to identify the effects of mindfulness practice on reducing perceived stress in occupational therapy students enrolled in a graduate program who are beginning the clinical phase of their education. It is important for future health-care providers to learn the importance of self-care and to develop skills to care for their own physical, emotional, social, and spiritual well-being. Health-care providers do not seek to learn such skills frequently until burnout and compassion fatigue are evident. Students in this graduate program follow a nontraditional full-time format. Students are on campus 6 weekends a trimester and there is a great deal of work outside of class time that must be accomplished. In addition, many graduate students work full time while attending school. This leaves students little time to engage in mindfulness workshops and activities that are offered during the typical college weekly schedule. Providing students with opportunities to learn about and practice mindfulness in a way that fits into their full schedules will hopefully help them cultivate positive habits and routines that they will carry into their clinical education and into their work lives after graduation. Objectives: At the end of this session, participants will be able to explain the benefits of integrating opportunities for mindfulness education and practice into the curriculum for graduate health professions students; describe the ways mindfulness practice was introduced into course sessions during the trimester during this study; reflect on ways in which they might incorporate similar programs into their practice settings. (3850) Adherence to Mind–Body Therapies: A Systematic Review and Meta-analysis Malik Shaw1, Michelle Park, BA1, Raveendhara R Bannuru, MD, PhD1 and Chenchen Wang, MD, MSc1 1Tufts Medical Center, Boston, Massachusetts Abstract Purpose: Non-pharmacological treatments such as exercise have suffered from low adherence, the degree to which a patient correctly follows a prescribed treatment. Recent evidence indicates mind–body therapies may be effective in managing knee osteoarthritis. However, adherence to mind–body treatments that incorporate both physical and psychological components remains unknown. We systematically review evidence on adherence to mind–body interventions for knee osteoarthritis. Results: Ten RCTs, published between 2000 and 2016, with a total of 954 subjects (67.7% women) met our inclusion criteria. Sample sizes varied between 33 and 250. Mean age was 66.5 years, and treatment durations ranged from 8 to 18 weeks. Duration of knee osteoarthritis ranged from 2 months to 1 year (Table 1). Four studies were on yoga, 5 were on Tai Chi, and 1 was on qigong. Of the 6 studies that reported on adherence, 4 studies defined adherence as attending ≥75% of sessions and 2 studies defined adherence as attending ≥50% of sessions. The overall adherence rate was 81% (95% Confidence Interval; 64%, 91%). For the 2 studies that defined their adherence as attending ≥50% of sessions, the overall adherence rate was 65%. Conclusions: The results of our study indicate that the adherence rate to mind–body therapies appears to be high in patients with knee osteoarthritis. Generalizability of our results may be limited by the quality of reporting among the available RCT evidence. Future trials should define adherence a priori and report it consistently to improve study quality. (3854) Impact of an Integrative Health Clinical Education Effort on Changing Clinician Attitudes and Behaviors Stephen R Shamblen, PhD1, Aree Sangpukdee, EdD1, Ben Kligler, MD2, Tracy Gaudet, MD2, Theresa Liao, MD2, Katharine A Atwood, MSc, ScD1, April Schweinhart, PhD1 and Adam Rindfleisch, MD3 1Pacific Institute for Research and Evaluation, Louisville, Kentucky 2Portland, Oregon 3University of Wisconsin, Madison, Wisconsin Abstract Purpose: The purpose of this study was to assess whether a 3-day clinical education course focused on Integrative Health (IH) and patient-centered care strategies, delivered to clinical staff at Veteran Health Administration (VHA) facilities, resulted in changes in attitudes, self-efficacy, preparedness to use non-pharmaceutical approaches to care, and self-reported use of Integrative Medicine (IM) strategies after 3-month follow-up. Results: Self report survey findings suggest that the clinical course was associated with attitudinal and behavioral changes at the 3-month follow-up, including increases in attitudes toward IH, self-efficacy to engage in IH strategies, perceived preparedness to discuss nonpharmaceutical approaches to care, and greater use of IH strategies during clinical encounters. Differential impacts were found for participant age, gender, occupational role, and whether the participant volunteered or was required to attend. Conclusions: Findings suggest that a brief, experiential course, designed to be a foundational strategy in driving transformation, is effective at achieving sustained shifts in attitudes and self-reported use of IM strategies. (3860) Introduction to Functional Nutrition Increases Provider Preparedness and Self-efficacy Theresea Liao, MD1, Nancy A Cotter, MD1, Gail Meissen, RDN2, Sherry Brewer, MD3, Sherri Pollack, RDN3, Anne Utech, PhD3, Marite Hagman, MPH4, William Scarbrough, PhD5, Adam Rindfleisch, MD4 and April Schweinhart, PhD5 1Veterans Health Administration, Montclair, New Jersey 2Veteran Health Administration, Madison, Wisconsin 3Veterans Health Administration, Washington, DC 4University of Wisconsin, Madison, Wisconsin 5Pacific Institute for Research and Evaluation, Louisville, Kentucky Abstract Purpose: As part of its clinical education initiative, the Veteran’s Affairs Office of Patient Centered Care and Cultural Transformation introduced a new, 2-day course for clinicians entitled, Eating for Whole Health: Functional Approaches to Food and Drink. Two pilot implementations of the course were evaluated using both qualitative and quantitative methods to determine the distribution of course participants, their reactions to the course, and how they improved on measures designed around course outcomes. Results: There were no significant improvements in self-care from pretest to follow-up, although this was likely due to high baseline level reports on this outcome (M = 3.1, range = 1–4). Similarly, 1 implementation showed no significant increase in Mindful Eating from pretest to follow-up, again, likely due to high baseline levels (M = 3.1, range = 1–4). However, both implementations showed significant improvements in Nutritional Preparedness (P < .001) and Nutritional Self-efficacy (P < .001) from pretest to posttest which were sustained at follow-up. Moreover, findings from the focus group indicated participants would be bringing strategies they had learned in the course, such as Mindful Eating, back into their own lives and into their practice with patients. Conclusions: The results of these pilot course implementations show that a short, provider-focused course designed to introduce a Whole Health approach to nutrition can have sustained impacts on provider self-reports of Preparedness and Self-efficacy for discussing functional nutrition with patients. (3862) Implementing an Inner-city Prenatal Yoga Program: A Case Study at Newark’s University Hospital obstetrician-gynecologist Clinic Kristen Harris1, Emily Babiss1, Lisa Gittens-Williams, MD1, Alejandrina Canelo Villafana, MS1 and Katherine Salamone, MA1 1New York, New York Abstract Overview: Prenatal yoga is a subgroup of yoga for pregnant women. It includes breathing exercises, meditation, and poses tailored at easing the physical and emotional changes women undergo during pregnancy and delivery. Studies evaluating prenatal yoga suggest a range of benefits. A systematic review evaluating 10 randomized control trials suggests prenatal yoga intervention was associated with lower incidences of prenatal disorders and small for gestational age births. Studies also showed yoga interventions were associated with lower levels of pain and stress. The prenatal yoga program at University Hospital Prenatal Clinic in Newark, NJ was introduced in April, 2017. This inner-city clinic serves a predominantly African American and Hispanic population, where the average household income is $33 139. Women in Essex County have a higher rate of preterm birth than the state average and are more likely to deliver low birth weight infants. The existing Lifestyle Pregnancy Program (Centering Pregnancy for Diabetes and Obesity) provides an integrative approach to care for high-risk pregnant women. Patients attend group sessions with a physician, facilitators, and content experts where lifestyle management and long-term health maintenance are discussed. Our prenatal yoga program was introduced during the Lifestyle Centering Program. A similar session was delivered in the clinic waiting area to broaden patient exposure. A certified yoga instructor developed a 20-min sequence of chair yoga postures and trained 2 medical students who delivered the program to women of any gestational age. Sessions began with alternate-nose breathing and stretching. Six active postures followed to emphasize stretching and strengthening, including Star, Tree, Chair, and Downward-Facing Dog. Following each session, patients were asked if they had questions, given an illustrated representation of the postures, and encouraged to repeat the sequence at home. There were 19 participants in the Lifestyle Pregnancy Program and 28 participants in the waiting area sessions. Rationale: Prenatal yoga has been shown to have positive health effects for both mother and baby. Our aim was to introduce the practice of yoga to women in our at-risk patient population to increased awareness and accessibility. Yoga is most commonly practiced among non-Hispanic, white, college-educated, female, and young- to middle-aged adults; and the prenatal period is an important time to introduce and emphasize wellness practices; successful program implementation required collaboration between patients, obstetrician-gynecologist practitioners, clinic staff, and medical students. Objectives: Our objectives in testing this prenatal yoga program were to determine whether implementation of the program was feasible, report barriers to initiation, and assess patient response; conference participants will gain an appreciation for the potential benefits of prenatal yoga and will learn about starting a prenatal yoga class in an underserved population. Tools to initiate prenatal yoga classes in similar environments will be provided. (3863) The Effects of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta-analysis Rhayun Song, RN, PhD1, Pamela Rist, ScD2, Audrey J Hernandez, MS2, Carolyn Bernstein, MD2, Matthew Kowalski, DC2, Kamila Osypiuk, MS2, Cynthia R Long, PhD3, Peter M Wayne, PhD4, Christine M Goertz, DC, PhD3 and Robert D Vining, DC3 1Chungnum National University, Daejeon, Republic of Korea 2Boston, Massachusetts 3Palmer College of Chiropractic, Davenport, Iowa 4Brigham and Women's Hospital, Boston, Massachusetts Abstract Purpose: Migraine is one of the leading causes of disability worldwide. Manual therapies and spinal manipulation are among the most commonly used nonpharmacologic approaches for treating migraines. We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) to evaluate the evidence regarding spinal manipulation as an alternative or integrative therapy in reducing migraine pain and disability. Results: Our search identified 6 RCTs (pooled n = 677; range of n = 42–218) eligible for meta-analysis. Of the 6 studies, 5 compared treatment groups to active controls (e.g., sham electro-stimulation, medications, and spinal mobilization). Intervention duration ranged from 2 to 6 months; outcomes were assessed between 0 and 52 weeks posttreatment. Outcomes indicated high levels of heterogeneity among studies (I2 = 72.6% and I2 = 82.7% for pain and disability, respectively). Methodological quality scores indicated low bias in 2 trials, moderate bias in 3, and high bias in 1. Random effects models indicated that spinal manipulation significantly reduced pain with an overall moderate effect size (Hedges’ g = −0.69; 95% CI −1.13, −0.26; P < .001). Spinal manipulation also significantly decreased disability with an overall moderate effect size (Hedges’ g = −0.70; 95% CI −1.21,−0.19; P = .007). Conclusions: Spinal manipulation may be an effective therapeutic technique to reduce migraine pain and disability. Methodologically rigorous, large-scale RCTs are warranted to better inform the evidence base for spinal manipulation as a treatment for migraine. (3865) What is the Appropriate Duration of Care for Chronic Low Back and Chronic Neck Pain Patients? Patricia M Herman, ND, PhD1 and Mallika Kommareddi, MPH 1RAND Corporation, Santa Monica, California Abstract Purpose: Chronic low back pain (CLBP) and chronic neck pain (CNP) are two of the most prevalent types of chronic pain. Spinal manipulation is one recommended treatment for this pain, commonly delivered by chiropractors. However, little work has been done on the appropriate duration of this care for this population. Results: Essentially all these patients have been in pain for years (M = 13.8, SD = 13.0), have been receiving chiropractic care for years (M = 10.9, SD = 11.6), and perceive that their pain would be substantially higher (M = 6.8 SD = 2.2 on a 0–10 scale) than current levels (M = 3.1 SD = 3.8 on a 0–10 scale) if they did not see their chiropractor. During the 3-month data collection period, only 131 (8.0%) of patients ended their chiropractic care and 51 (38.9%) of these also restarted it again, so continuous chiropractic care is fairly common for this population. The HLM models indicate that on average pain and function improved slowly and significantly for patients over the 3-month period. However, those with both CLBP and CNP have worse pain and function than others with only CLBP or CNP and their pain and function improvement is even slower. The longer someone has been in pain also slows pain and function improvement. However, those who report higher estimates of what their pain would have been without going to the chiropractor improve more over time. Conclusions: What seems to be working for these patients is continuous (aka maintenance) care. Unfortunately, not enough ended care (and ended it because of no longer needing care) during this period to enable prediction of a patient-satisfactory end of care. Instead, the higher pain values reported by patients as what they would experience without chiropractic care provide an argument for maintenance care. (3866) The Unani Medicine Approach to Dietetics: Using Food Energetics to Balance the Patient’s Temperament (Mizaj) Samira S Ardalan, BA1 and Hakima Amri, PhD1 1Washington, DC Abstract Overview: Unani Medicine originated in the Eastern-Mediterranean region and was systematized and compiled by Ibn Sina (Avicenna) in his Canon of Medicine. Unani Medicine is another alternative medical system that looks at the body as a whole, instead of by its individual parts. Ibn Sina’s practices and proven methods of natural healing are still being taught today throughout various continents across the globe. In this work, we focus on the importance of diet in Unani Medicine, or the influence of foods and drinks on the maintenance and preservation of health using modern scientific discoveries. Most illnesses arise solely from long-continued errors of diet and regimen. The Unani approach to food and dietetics is contingent on the individual eating the right foods and drinks, in the right quantity, at the right time/season, to maintain balance, good health, and prevent disease. In Unani medicine, the Mediterranean-inspired diet consists of simple, all natural, dishes, snacks, and drinks that balance one’s unique Mizaj (Temperament). One’s Mizaj characterizes their fundamental makeup and the vital energies that flow within their body, mind, and spirit. We will discuss the modern interpretation of the elemental qualities of one’s Mizaj (i.e., hot, cold, wet, and dry), which help the practitioner understand what foods and drinks are best for the patient. For instance, if the dominant Mizaj consists of the Earth qualities (cold and dry); it is advised to consume warming foods to balance the cold that the patient’s body naturally presents. Although Avicenna’s explanation of each step is based on the theories and principles of his time (humors, elements, and temperaments), his explanatory model holds still true today in light of our modern interpretation of health and disease. Rationale: This topic in important as it discusses the relevance of food and diet as presented in Unani Medicine. Objectives: Participants will learn how Unani Medicine views food and diet when treating patients and find about the importance of food energetics. (3867) Employing Evidence in Evaluating Complementary Therapies: Findings From an Ethnography of Integrative Pain Management at a Large Urban Pediatric Hospital Isabel Roth, MS, DrPH (c)1, Joan Engebretson, DrPH1, Linda Highfield, PhD1, Paula Cuccaro, PhD1, Rebecca Wells, PhD1 and Sanghamitra M Misra, MD2 1UTHealth School of Public Health, Houston, Texas 2Baylor College of Medicine, Houston, Texas Abstract Purpose: Ethnographies of integrative health-care models have revealed intricate social, professional, and ideological challenges between biomedical practitioners and complementary therapists. The need for in-depth observation on the impact of integrative medical care on patients has been implicated as a promising future direction by past researchers. This study aimed to better understand the role evidence played in the process of integration of complementary and integrative therapies into a large urban pediatric hospital from the perspective of patients, caregivers, providers, and administrators through applied medical ethnography. Results: Analysis of the data revealed 5 themes regarding the role of evidence in the process of integration: Anecdotal Evidence and Personal Experience Effecting CIM Use, Open to Trying Whatever Works, Resistance to the Unfamiliar, Patients and Parents Trusting Doctors as Experts, and Importance of Scientific Evidence to Biomedicine. All themes address the role of evidence in relation to cultural acceptance of complementary therapies and correlate with 3 thought processes: critical thinking, relying on others for evidence, and reactionary thinking. Conclusions: As biomedical environments seek to integrate IM into pain regimens, education and training are needed for providers, administrators, and families about the context and evidence for IM. In order to create a truly patient-centered healing encounter, families must be empowered to participate in the decision-making process and bring their own personal and cultural knowledge into their health care. (3868) Art therapy Program for Parents-caregivers Inside the Bone Marrow Transplant Unit (UTMO) at Hospital de Niños Dr Luis Calvo Mackenna Ilana D Solowiejczyk, MA1, Luis Calvo Mackenna2 and María Inés Villanueva1 1Hospitalde Niños 2Santiago, Chile, Santiago, Chile Abstract Overview: This work presents an ongoing experience using art therapy (AT) to promote health and provide support to parents-caregivers of hospitalized and isolated children in the Bone Marrow transplant Unit UTMO children in an isolation unit for bone marrow transplants at the Hospital de Niños Dr Luis Calvo Mackenna in Santiago, Chile. This hospital is a national referral center for complex pathologies. Many patients come from distant locations to be transplanted. Both patients and caregivers stay in isolation for at least 41 days in order to complete the transplant protocol. Caregivers often face disruption of their personal, family, and professional life in addition to the responsibilities and emotional cost of caring for a sick child. Financial stress is added to the difficulties of living in a restricted space with strict rules and schedules. They assume this new role at the expense of losing their sense of identity, independence, and decision-making abilities. Program objectives include: improve socialization, promote health and well-being, and strengthen caregivers coping skills. AT sessions are held weekly inside the 8 bed unit so parents can tend to their children if required. The number of participants per session ranges from 0 to 8 and the average number of sessions attended is 4. A total of 32 caregivers have participated since November, 2016. Difficulties establishing a consistent AT setting and schedule, frequent interruptions and lack of privacy are addressed as well as adjusting to the restrictions on quantity and type of materials allowed in the Unit. High patient turnover and discharges and death of patients may affect attendance and objectives and interfere with follow-up and evaluation efforts. Every session and art production is registered. Overall, caregivers have informally reported satisfaction and increased interest in attending and motivating the hospital and a private foundation to support implementation of new AT programs. Rationale: Taking care of the caretakers will ultimately reflect in the quality of care they can provide for their children. The Hospital is a national referral center for complex pathologies and many patients come from distant locations in the country to be treated and hopefully transplanted. Both patients and caregivers must live in an isolated unit for at least 41 days in order to complete the rigorous transplant protocol. The center of attention is certainly the child and parents or other caretakers are often left aside. They might face severe disruption of their personal, family, and professional life. High levels of fatigue, stress, and loneliness are common. Most of the families have been dealing with diagnosis for a long time. The inability to care for other children left at home and financial stress due to the high costs of treatment, relocation, and so forth, is added to the difficulty of living in a restricted space with strict schedules and rules, caring for a very sick child. caretakers might assume this new role at the expense of their sense of identity, loss of independence, and decision-making ability. This public hospital has been unable to address the needs of the parents and caregivers. This is an innovative AT experience in Chile. Parents-caretakers have not been served inside transplant units, allowing them to continue being close to their kids while sharing and creating with a group of adults going through the same hopeful and painful treatment. Objectives: Participants will learn an innovative way of supporting caretakers’ health and well-being in a hospital environment; how art therapy can offer a new delivery model, providing a safe space for adults in an isolated unit in a children hospital; about the reality of a public hospital and population in Santiago, Chile; participant will hear about the challenges of doing art in an isolation unit, as well as the success of the experience; and participants will share their views and ideas for improving the program and hopefully help design a method for evaluating this program. (3869) Use of Complementary and Integrated Health: A Retrospective Analysis by U.S. Veterans With Chronic Musculoskeletal Pain Nationally Anita Yuan, PhD1, Patricia Herman, PhD2, Karen Chu, MS1, Karl Lorenz, MD3, Nell J Marshall, PhD4 and Stephanie L Taylor, PhD, MPH5 1Los Angeles, California 2RAND, Santa Monica, California 3Veterans Health Administration, Palo Alto, California 4Palo Alto, California 5VA Greater Los Angeles Healthcare System, Los Angeles, California Abstract Purpose: Chronic musculoskeletal pain is highly prevalent, but there are concerns with the risks and benefits of common therapies. Complementary and integrative health (CIH) therapies, including yoga, meditation, and acupuncture, are important nonpharmacologic options. Health-care systems are increasingly offering CIH therapies, and the Veterans Health Administration (VA), the nation’s largest integrated health-care system, has been at the forefront of this movement. Examining CIH therapy use for musculoskeletal pain could inform opportunities to improve CIH therapy uptake. Results: In our cohort, 15% used meditation, 7% yoga, 6% acupuncture, 5% chiropractic, 4% guided imagery, 3% biofeedback, 2% tai chi, 2% massage, and 0.2% used hypnosis, with 27% using any. Those who were more likely to use any CIH therapy (at P<.0001 level) included female (33% probability) versus male (23% probability), single (27% probability) versus married (22% probability). Conclusions: Use of CIH therapies is prevalent among veterans with chronic musculoskeletal pain. Low rates of some specific CIH therapies and associations of CIH with a growing population of single and female, veterans suggest the potential to augment CIH use. Given CIH use by one quarter of veterans, evaluating clinical impact appears feasible. (3871) Wellness Interventions for Medical Residents—Do Animals Beat Machines? Peter J Bayley, PhD1, Mala C Mandyam, MD1, Rachael Cho, MSEd1, Lisa Shieh, MD, PhD1 and Danielle C Mathersul, PhD1 1Palo Alto, CA, United States Abstract Purpose: Physician burnout contributes to workplace stress and has been shown to negatively impact patient care. One underutilized potential avenue for improving physician wellness is break time. Anecdotal evidence suggests that physicians often spend their brief periods of free time on their smartphones. However, some studies suggest that excessively accessing social media, news, and e-mails can be detrimental to mental health, increasing social isolation and discontent. Animal-assisted therapy is known to benefit hospital patients with various conditions, including mental illness, postoperative pain, and cardiovascular disease. Recognizing the benefits of therapy animals, health-care facilities now offer these services to staff. Pet Assisted Wellness at Stanford (PAWS) is a group of volunteer owners and dogs that regularly visits inpatients and may also be available to staff. Results: Preliminary data from 34 Stanford internal medicine residents (50% F, 29.18 years (SD = 3.27); 50% PAWS condition) were analyzed. Interestingly, while residents in the PAWS condition had significantly greater reductions in self-reported stress (P < .001) than the smartphone condition, they also had significantly lower HF n.u. (P = .045) and a trend toward a higher LF:HF (P = .086). Conclusions: Together, these preliminary findings suggest that while the PAWS condition increased arousal (possibly due to the excitement of the dogs and the dynamic change to the work environment), it had positive effects on overall well-being. (3872) Making Mindfulness Accessible for First Responders: A Novel Immersion Approach Joshua B Kaplan, MS1, Richard Goerling, MBA2, Candice H Kennedy, MS1 and Michael Christopher, PhD1 1Pacific University, Hillsboro, Oregon 2Hillsboro Police Department, Hillsboro, Oregon Abstract Overview: Exposure to critical incidents place law enforcement officers (LEOs) at an increased risk for adverse psychological and physiological health outcomes when compared to the general U.S. population. Mindfulness-Based Resilience Training (MBRT) is an 8-week intervention designed to enhance psychological and physiological health among first responders. In a recent RCT, MBRT participants experienced greater reductions in salivary cortisol, self-reported aggression, burnout, alcohol use, and sleep disturbance, relative to waitlist controls. However, some participants were unable to commit to an 8-week training model. To enhance program accessibility and adherence, we developed a 2-day immersion model. Rationale: The goal of this session is to present the clinical outline of the MBRT immersion model. The immersion training includes topics such as an orientation to the concept of mindfulness, psychoeducation on the mind–body relationship, stress reactivity, and barriers to mindfulness practice. Formal mindfulness practices such as body scan, awareness of breath, sitting meditation, and mindful walking are described, practiced, and discussed. Integrating mindfulness into on- and off-duty tasks is also emphasized. Brief practices will be reviewed during the presentation. Objectives: MBRT is an innovative mindfulness-based intervention (MBI) tailored to first responder culture. The 2-day immersion model may enhance accessibility for LEOs, allowing participation in a MBI that may be inconvenient in an 8-week format. Research following outcomes associated with participation in the immersion model is in its tentative stages and continues to develop in an effort to better understand and promote mechanisms of LEO health. Session attendees will gain introductory knowledge in conducting intensive MBIs with first responders. (3875) National Survey of Veteran Interest in and Use of Complementary and Integrative Health Approaches Stephanie L Taylor, PhD, MPH1, Benjamin Kligler, MD, MPH2, Katherine Hoggatt, PhD2, Alison Whitehead, MPH2 and Amanda Hull, MPH2 1VA Greater Los Angeles Healthcare System, Los Angeles, California 2Washington, DC Abstract Purpose: A major expansion of the provision of complementary and integrative health (CIH) approaches is underway at the Veterans Health Administration (VA), the nation’s largest integrated health-care system. However, we know little about veteran-reported interest in and use of CIH approaches. As such, we conducted a national survey to examine this issue. Results: At least half of veterans were interested in trying/learning more about 6 CIH approaches (72% for massage therapy, 63% for chiropractic, 56% for acupuncture, 54% for acupressure, 50% for reflexology, and 50% for progressive relaxation). In the past year, 23% used massage therapy, 20% used chiropractic, 18% used meditation/mindfulness, 13% used yoga, 11% used progressive relaxation, and 9% used acupuncture. Veterans reported using meditation/mindfulness (8%) or animal-assisted therapy (7%) at least weekly; and meditation/mindfulness (14%), massage (12%) or chiropractic (11%) a few times a month/about once a month. Pain was the most frequent reason for using CIH approaches (93% of acupuncture users, 92% of chiropractic users, and 75% of massage users). Stress reduction was the second most frequent reason for use. On average, less than half reported CIH was helpful for the conditions they used it for. The strong majority were unaware of specific CIH therapies being available at the VA. Conclusions: Veterans use CIH approaches at rates similar to or slightly higher than those of the general population. However, additional patient encouragement or education might be needed to increase the frequency of CIH use, which might be required for efficacy. (3877) Predictors of Engagement in a Yoga Intervention for Spanish-speaking Cancer Survivors Elizabeth L Addington, PhD1, Bruriah Horowitz, MEd1, Judy Guitelman2, Carly Maletich, MA1 and David Victorson, PhD1 1Chicago, Illinois 2ALAS-WINGS, Chicago, Illinois Abstract Purpose: To examine predictors of engagement in yoga classes and home-based practice among cancer survivors participating in a community-based, Spanish-language yoga pilot study. Results: Participants (N = 36) were primarily (89%) female breast cancer survivors. Age ranged from 30 to 78 years (M = 56, SD = 10.42). On average, participants attended 9 yoga classes and engaged in home practice 3 days/week during the 12-week intervention. During the 12-week follow-up period, yoga use averaged 3.6 days/week. Yoga use during the intervention and the follow-up period did not significantly correlate. Cancer history and sociodemographic characteristics were not significantly related to yoga use. Positive affect and well-being was the only significant predictor of class attendance. In bivariate analyses, home practice of yoga during the intervention period was significantly higher among participants without a history of back pain or migraine headaches and those with better physical function, less pain interference, and lower levels of depression at baseline. Only migraine history remained significant in the multivariate regression. Engagement in yoga during the follow-up period was higher among participants with higher baseline BMI and those without a history of back pain or migraine headaches, with only BMI remaining a significant predictor in multivariate regression. Conclusions: Among Spanish-speaking cancer survivors, psychological well-being and overweight/obesity can facilitate engagement in yoga. Despite benefits of yoga for pain, migraine headaches can be a barrier to home-based yoga practice. (3878) Estimating the Cost-effectiveness of Spinal Manipulation, Exercise, or Self-management for Neck or Back Pain in the United States Using an Individual Participant Data Meta-analysis Approach Roni Evans, DC, MS, PhD1, Brent Leininger, DC2, Pamela Jo Johnson, MPH, PhD2, John Nyman, PhD2, Gert Bronfort, DC, PhD2, Jim Hodges, PhD2 and Karen Kuntz, ScD2 1University of Minnesota, Minneapolis, Minnesota 2Minneapolis, Minnesota Abstract Purpose: Spinal pain is a common and disabling condition with considerable socioeconomic burden. The management of spinal pain in the United States has gathered increased scrutiny amidst concerns of overutilization of costly and potentially harmful interventions and diagnostic tests. Complimentary and integrative health-care interventions such as spinal manipulation may provide value for the care of spinal pain, but little is known regarding the cost-effectiveness of these interventions within the United States. Our primary objective for this project is to estimate the incremental cost-effectiveness of spinal manipulation, exercise therapy, and self-management for spinal pain using an individual patient data meta-analysis approach. Conclusions: This project represents a unique opportunity to combine clinical and economic data collected alongside a number of clinical trials with similar methodologies. The findings will provide important information on the value of spinal manipulation, exercise therapy, and self-management for spinal pain in the United States. (3880) Restoring Balance: Lifestyle and Mind–Body Management of Chronic Inflammatory Symptoms and Adrenal Fatigue Kaylan Baban, MD, MPH1 and Zulianna Ibrahim, MSc1 1Washington, DC Abstract Overview: Lifestyle and mind–body management holistically assess wellness with a focus on root causes and sustainable personalized behavior change, to support patient goals while maximizing their health resilience and minimizing potential pharmaceutical-related adverse effects. Rationale: Thirty-one-year-old female health-care consultant and graduate student with history of anxiety, irritable bowel syndrome (IBS), attention deficit (Adderall as needed), hypothyroidism (Synthroid daily) presented with fatigue, full-body myalgias and arthralgias described as moderate to severe, that interfered with her studies, with worsening IBS symptoms for 8 months. Physical exam; basic laboratories; viral, rheumatologic, and thyroid panels; and colonoscopy were unremarkable. She reported strong social support and twice-weekly dedicated physical activity in the setting of poor quality and limited quantity sleep, pro-inflammatory foods with regularly skipped meals, and a mostly sedentary, high stress lifestyle for several years, recently intensified. Initial assessment identified a pattern of symptoms consistent with generalized chronic inflammation and adrenal fatigue, likely exacerbated by Adderall. Recommended behavior changes targeted lifestyle imbalances based on history and symptomatology. Shared decision-making and motivational interviewing guided personalization of sustainable goals, tools, and timeline. Management included circadian support (sleep hygiene, melatonin, and tryptophan), dietary modification (anti-inflammatory foods—including probiotics and turmeric—and regular meals), adrenal support (Ashwaghanda, B12, hydration, and discontinuation of Adderall), and mindfulness-based stress management (anchoring on breath and movement). Over a 7-month period without diminishing her professional activities, our patient reported full resolution of myalgias, arthralgias, fatigue, and IBS symptoms, and self-reported wellness improved from baseline with sustained restful sleep, anti-inflammatory dietary habits, regular physical activity and mindfulness practice, prioritization of hydration and meals, and successful long-term discontinuation of Adderall, maintained at 4-month follow-up. Objectives: A young adult with a high-intensity career sustainably resolved inflammatory symptoms and improved health resilience through guided lifestyle change without pharmaceuticals or sacrifice to her professional goals. (3882) A Qualitative and Systematic Review of Multimodal Weight Management Interventions for the Treatment of Migraine Meg Sweeney, BS1 and Robert A Bonakdar, MD, FAAFP, FACN2 1The College of Osteopathic Medicine, Western University of Health Sciences, Pomona, California 2La Jolla, California Abstract Background: Headache and obesity are prevalent public health issues that impose significant societal burdens. Both conditions are hampered by low treatment efficacy and dissatisfaction with currently available treatments, which highlight the unmet needs in this population. Researchers have identified a 27% to. Methods: We completed a qualitative and systematic review of PubMed, Embase, databases for trials that evaluated weight loss interventions in the setting of migraine in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Additionally, trials were reviewed for potential mechanisms related to migraine reduction as well as comparative efficacy of evaluated interventions. Findings: A total of 14 trials were identified which evaluated weight loss in the setting of pediatric and adult migraine. Interventions were broadly categorized as surgical, nonsurgical-behavioral and nonsurgical-multicomponent. A systematic review was not possible due the heterogeneity of the interventions and populations evaluated. A qualitative review noted that weight loss was associated with reduction in migraine severity with multiple potential interventions. Surgical interventions were associated with enhanced migraine reduction with similar levels of weight loss versus nonsurgical interventions. Additionally, the level of obesity and insulin resistance was inversely associated with migraine reduction. Multiple mechanisms were postulated including modulation of inflammation, adipokines, and lifestyle factors (sleep, stress, and physical activity) known to effect migraines. Conclusions: Obesity and weight management appear to be promising interventions in the setting of migraine. Several potential interventions may be of benefit with additional trials required to elucidate ideal parameters. Based on available evidence, recommendations are provided for optimizing staging, compliance, and outcomes of weight loss interventions in the setting of migraine. Rationale: Obesity and migraine are conditions which create large medical, financial, and societal burdens. Migraine affecting roughly 1 of every 7 Americans and causes more than 100 million days/year of missed work with an annual cost of $13 billion related to missed work and medical care. Obesity effects at least 36% of U.S. adults with an estimated cost at $147 billion/year. Unfortunately, both conditions are associated with dissatisfaction with currently approved medication treatments. Recently, weight management research trials have demonstrated benefit in synergistically improving obesity and migraine disability in certain populations. It is important for providers and researchers to be aware of this emerging research in order to help provide enhanced and integrative options for helping patients with comorbid migraine and obesity to find patient-centered treatments. Objectives: The aim of this study was to understand the association between obesity and migraine headaches; review potential mechanisms of how weight management can improve migraine status; analyze what type of weight loss interventions may work best in certain populations with comorbid migraine and obesity; and review factors that help predict compliance with weight management interventions in the setting of headache (3883) The Antihyperalgesic Effect of Continuous and Interval Running on Mechanical Hyperalgesia and Cytokine Levels in an Animal Model of Complex Regional Pain Syndrome Type 1 Francisco Cidral-Filho, PhD1, Afonso Salgado, PhD1, Daniel F Martins, PhD1, Franciane Bobinski, PhD2, Daiana C Salm3, Bruna H Oliveira1, Kamilla P Frech1, Luana M Belmonte1 and Luiz OA Belmonte1 1University of Southern Santa Catarina, Palhoça, Brazil 2University of Souther Santa Catarina, Florianopolis, Brazil 3University of Federal of Santa Catarina, Florianópolis, Brazil Abstract Purpose: To evaluate the antihyperalgesic effect of continuous and interval running on mechanical hyperalgesia and cytokine levels in an animal model of complex regional pain syndrome type 1 (CRPS-I) Results: Both the continuous and interval running groups showed a higher threshold in mechanical hyperalgesia from the 1st to the 5th day of training (P < .05) as well as lower levels of TNF-α and IL-6 in the spinal cord, brain stem, and prefrontal cortex when compared to the nonexercised group. Interestingly, the interval group experienced a more prolonged antihyperalgesic effect for up to 5 h postrace, higher levels of IL-10 in the brainstem and prefrontal cortex, as well as lower levels of IL-6 in the same structures when compared to the continuous running group. Conclusions: Interval running produces greater analgesia than continuous running and this effect seems to be related to higher release of IL-10 and lower levels of IL-6 and TNF-α. (3884) Knowledge, Attitudes and Perceptions: What Medical, Dental and Pharmacy Students Report Regarding the Medical Use of Marijuana Aimee McRae-Clark, PharmD, BCPP1 and Lynneice Bowen, MD, MEd1 1Medical University of South Carolina, Charleston, South Carolina Abstract Purpose: The medicinal use of marijuana has been legalized in 28 states with a wide range of specificity for approved conditions. It is also the most commonly used illicit substance in the United States and the second most common substance for which people seek treatment. Physicians, dentists, and pharmacists should be at the forefront of shaping patient understanding of this topic; however, limited data have been gathered on the knowledge and perceptions of medical marijuana among health professions students and the learning gaps these trainees experience. Results: Three hundred eight full and partial responses were collected. Ten percent responded that they had sufficient knowledge to answer patient questions regarding efficacy of marijuana, 90% agreed that information regarding medical marijuana should be included in their curriculum. Only a third cited medical knowledge as the primary influence on their perception of the medical use of marijuana. The majority agree that marijuana has fewer negative health effects than prescription medications. Most reported that legalizing medicinal use would increase recreational use. Conclusions: 22.2 million people aged 12 or older use marijuana each month according to the 2015 National Survey on Drug use and Health. Policy changes have increased legal access to cannabis for medicinal purposes. Professional school students demonstrate knowledge gaps related to the medicinal use of cannabis and are using anecdotal level evidence to inform patient care. This represents an opportunity for educators. (3885) Beyond the Prescription Pad: Group Acupuncture for Chronic Pain Elaine Chu, MD1, Dean Sasaki, MD1, David Seto, MD1 and Kirsten Tillisch, MD2 1Los Angeles, California 2University of California, Los Angeles, California Abstract Background: Chronic pain is one of the most compelling issues facing the VA health care system. Our medical therapies often fall short. Acupuncture benefits chronic pain; however, its availability to Veterans is limited. With an enormous need for nonpharmacological pain treatments, group acupuncture visits were implemented to assess feasibility and acceptability to Veterans. Program Description: Our acupuncture program is embedded in the Division of Integrative Medicine at Greater Los Angeles Veteran’s Administration (GLAVA). Veterans with chronic pain are referred for acupuncture once a diagnosis is established. The initial visit includes a 1 h session discussing the pathophysiology of chronic pain, the biopsychosocial health model, a description of acupuncture including its risks/benefits, and our philosophy regarding the role of acupuncture as a bridge treatment best utilized in conjunction with self-care interventions. The GLAVA yoga, taichi, mindfulness, healthy eating, and holistic nursing programs are described. In the second hour, the Veterans receive acupuncture from a physician acupuncturist in a group setting. Healing touch and/or aromatherapy from holistic nurses is offered. Auricular protocols are utilized in the majority of patients at the first visit but any treatment achievable without disrobing can be used at the discretion of the acupuncturist. Pre- and posttreatment pain and anxiety ratings are recorded. In the first year, 265 Veterans participated, with a mean baseline pain of 6.4 (SD = 2.1) on a 0 to 10 scale. Pain decreased at the end of visit by 2.9 (SD = 2.0) and anxiety decreased by 2.6 (SD = 2.3). Visit satisfaction was 8.8 of 10 (SD = 1.75). Conclusion: Group acupuncture is feasible in a VA setting and is received with high satisfaction by Veterans. Further, the reduction in pain achieved in the visit is comparable to those reported in the literature. Rationale: New models for delivering integrative treatments for pain are essential in the VA system. In this abstract, we describe the delivery of acupuncture for pain in an enhanced group setting. Veterans receive acupuncture but also are provided with education and opportunities related to other evidence-based treatments of pain including yoga, tai chi, and mindfulness. Through collaboration with other providers in our Integrative Health Center, including holistic nurses, recreation therapists, and mental health providers, we are able to help Veterans implement a multifaceted treatment plan that is aimed at their overall well-being. Objectives: Participants will know how to implement a group-based integrative pain treatment program that results in pain reduction and high satisfaction. (3887) Does Dispositional Mindfulness Correlate With Blood Pressure Consistently Across Demographics? Baseline Analyses From the Serenity Study Rosa Heryak, BA1, Megan Strowger, MA1, Monica Fallon, MA2, Joel Hughes, PhD1, David Fresco, PhD1, Devin Barney, BA3, Mary Keenan, BA4, Jeffery Greeson, PhD5, Vanessa Anyanso, BA6, Jonathan Reda, BS6 and Gabrielle Chin, BS5 1Kent State University, Kent, Ohio 2University of Mannheim, Stuttgart, Germany 3Manoa, Hawaii 4University of Memphis, Memphis, Tennessee 5Rowan University, Glassboro, New Jersey 6Philadelphia, Pennsylvania Abstract Purpose: Mindfulness is consistently associated with subjective measures of mental health; however, few studies have addressed the relationship between dispositional (aka “trait”) mindfulness and physical health. Utilizing baseline data from the ongoing Serenity Study (NCT02371317), we aimed to examine if trait mindfulness correlates with blood pressure (BP) levels consistently across demographic subgroups, including race, gender, and socioeconomic status (SES). Results: In African-Americans (n = 59), BP was significantly and negatively correlated with two facets of mindfulness, observing, r(59) = −.401, P = .002, and nonreactivity, r(59) = −.374, P = .004. In contrast, Caucasians (n = 141) showed positive correlations across three mindfulness scales, Nonjudgment, r(141) = .191, P = .023), nonreactivity (P = .04), and observing, r(141) = .174, P = .087. Gender differences produced mixed results, such that some facets of trait mindfulness correlated positively with BP, while others correlated negatively with BP, as a function of gender. For SES, observing negatively correlated with BP for lower income households, r(52) = −.372, P = .007, but positively in higher income households, r(138) = .215, P = .011. Conclusions: Taken together, results show that trait mindfulness correlates with BP differently across demographic subgroups, at baseline, prior to mindfulness training. Therefore, future studies that attempt to relate questionnaire measures of mindfulness and objective measures of health should consider examining such associations separately, by demographics, to better understand implicit variables within demographics and to avoid assuming that associations remain the same across diverse groups. (3891) Mindfulomics: Searching for the Molecular “Signature” of Mindfulness Mary Keenan, BA1, Devin Barney, BA2, Jonathan Schug, PhD3, Jonathan Reda, BS3, Vanessa Anyanso, BA3, Xiangdong Ren, MD, PhD4 and Jeffrey M Greeson, PhD5 1University of Memphis, Memphis, Tennessee 2University of Hawaii at Manoa, Honolulu, Hawaii 3University of Pennsylvania, Philadelphia, Pennsylvania 4The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 5Rowan University, Glassboro, New Jersey Abstract Purpose: New studies have recently emerged that investigate changes in gene expression with mindfulness meditation, a field we term Mindfulomics. Mindfulness, though, is a multifaceted construct; it is at once a state (induced during meditation), a trait (an enduring disposition), and a skill (developed through practice). No published studies have examined genomic or other biologic “signatures” of mindfulness in this multifaceted way. Results: Contrary to hypotheses, there were no differences in resting-state blood biomarkers or gene expression post-mindfulness-based stress reduction (MBSR), nor any difference in gene expression as a function of either state mindfulness (meditation vs quiet rest) or trait mindfulness (Cognitive and Affective Mindfulness Scale – Revised score; median split). There was a significant decrease in resting-state salivary α-amylase (P < .05) post-MBSR. A trend toward decreased CTRA gene expression was found for MBSR responders who showed a 50% increase in mindfulness (P = .12). Several changes in stress responsivity were also observed, including decreased emotional reactivity (P < .001), lower BP reactivity (P = .059), and stronger innate immune system reactivity (P = .049 for WBC count; P = .005 for neutrophils). Conclusions: These findings reveal some objective changes in stress biomarkers after 8 weeks of mindfulness training. Moreover, genomic results suggest that among relatively young, healthy adults, changes in stress-related and proinflammatory gene expression appear to be most pronounced for individuals who experience the greatest change in mindfulness after MBSR training. (3893) The Development and Implementation of an Integrative Medicine Diploma—The Portland Institute for Integrative Medicine, Bristol, UK Elizabeth A Thompson, MD1, Duncan Still, MD1, Patricia Turton, Ed1 and Alastair Gray, MSc2 1Portland Institute for Integrative Medicine, Bristol, UK 2University of Technology Sydney, New York, New York Abstract Overview: The swift adoption of integrative medicine (IM) by a willing public has not necessarily been paralleled with excellent educational provision about IM. While departments of integrative medicine are emerging especially in the private equity American university sector, this trend is currently not yet a feature of the United Kingdom, European, or Australian medicine education landscape. Previous attempts at establishing integrative medical programs have been met with resistance and opposition and ultimately not thrived. The Portland Institute for Integrative Medicine (PCIM) diploma of IM is an initiative to develop and run a 2-year accredited qualification in IM for licensed health-care providers. The program is a 1200-h 120 credit course accredited by Crossfield’s Institute based in the UK education space. Rationale: There were a number of challenges in the establishment of this world-class program, integrated medicine program. Enrolments should the institute only accept licensed medical or health-care providers? Whether to accept complementary medicine practitioners. If not, why not? Compliance—resistance is from local universities to accredit and support the program. Technology and curriculum design—the clear challenges presented by an interested potential student body but who are overwhelmed, overworked, and have little time in their busy professional lives for further educational opportunities. It was for this reason that PCIM adopted a blended e-learning and face-to-face model of learning that relied heavily on a learning management system with asynchronous use of expert video lecture and synchronous use of student engagement including tutorial, webinar, and forum support. Objectives: This presentation will chart the challenges, hurdles, uptake, and uptake of technologies, as well as the capacity building required in the establishment of the world-class course of integrative medicine. In describing this journey, it seeks to start a dialogue between IM education leaders to discuss the mutual challenges provided by compliance, learning technologies, enrolments, and resistance from within and with out. (3896) Acupuncture as a Complementary Therapy for In Vitro Fertilization Patients: A Randomized Controlled Trial Cybelle M Costa, MD1, Clariana C Souza1, Julia G Lopes1, Victor H Melo, MD, PhD1 and Rubens LC Tavares, MD, PhD1 1Federal University of Minas Gerais, Belo Horizonte, Brazil Abstract Purpose: The aim of this randomized controlled trial is to evaluate the use of acupuncture as a complementary therapy for in vitro fertilization patients. Results: There was a statistically significant difference in the physical domain of the WHOQOL-Bref questionnaire after intervention (P = .029) and in the social aspects of the Short-Form 36 questionnaire (P = .033). FERTIQOL and DASS 21 did not show differences between the control and treatment groups. Conclusions: Our preliminary results demonstrated an improvement in the scores of the Physical domain of the WHOQOL-Bref and in the social aspects domain of Short-form 36. A larger number of patients will be necessary to confirm these preliminary results. (3897) Acupuncture for Chronic Pain in an Underserved Population: A Responder Analysis Robert B Saper, MD MPH1, Aaron B Afran1 and Eric Roseen, DC1 1Boston, Massachusetts Abstract Purpose: Challenges of long-term pharmacological management of chronic pain include insufficient pain relief and risk of addiction and overdose. To identify characteristics that predict favorable response to acupuncture for chronic pain among racially diverse low-income participants. Results: From August 2015 to March 2018, 218 patients were recruited at Boston Medical Center. Of these, 160 had chronic pain, 142 had received acupuncture, and 128 had completed baseline and 4 or 6 months of follow-up. Sixty-five patients met all three criteria, who were 74% female, 19–86 years old, and 59.7% non-white. Thirty-two percent of patients experienced a 30% or greater reduction of pain. Although not statistically significant, responders were more likely to be female (P = .13) and have private insurance (P = .14). Conclusions: Use of acupuncture for chronic pain achieved a clinically meaningful improvement in a third of patients with chronic pain. Following completion of PRIMIER data collection in December 2018, we will repeat our responder analysis using information from all (20) PRIMIER sites. (3900) Impact of Homeopathy and Acupuncture Treatment on the Quality of Life of Women: A Randomized Controlled Trial Julia G Lopes1, Clariana C Souza1, Paula C Costa1, Barbara L Justo1, Dayane M Dutra1, Adrienne M Mendes, MsC1, Claudia P Santos, MD1, Natalia S Champs, MD, PhD1 and Rubens LC Tavares, MD, PhD1 1Federal University of Minas Gerais, Belo Horizonte, Brazil Abstract Purpose: To evaluate the Quality of life (QoL) of women treated with homeopathy or acupuncture within the Public Health System of Belo Horizonte, Brazil. Results: Randomization afforded similar baseline results in all domains of QoL analysis for both groups. After 6 months of homeopathic treatment, there was a statistically significant difference between groups with or without treatment in the physical, social, and environmental domains. The biggest difference was within the physical domain, where the average score improved from 54.32 to 63.36 (P < .001). Beyond that, while comparing the subjective perception of their own health during the homeopathic treatment, treated patients displayed an improvement, while values in the control Group remained unchanged after 6 months (P = .002). However, between the experimental and control groups of patients for the acupuncture study, there was no statistical difference between them after the 6-month period. Conclusions: Homeopathic treatment showed a positive impact on the QoL of women with chronic diseases during the 6-month period. This positive impact was not found with the use of acupuncture. Further studies should be carried out to study the long-term effects of treatment with Complementary and Integrative Medicine on the QoL and their determinant factors. Financial Support: Faculdade de Medicina da Universidade Federal de Minas Gerais, Programa de apoio à Pós-Graduaça∼o - PROAP - CAPES, Programa de Pós-Graduaça∼o em Saúde da Mulher, Programa de Pós-Graduaça∼o em Promoça∼o da Saúde e Prevença∼o da Violencia, Fundaça∼o de Amparo à Pesquisa do Estado de Minas Gerais - FAPEMIG, Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq (401024/2013-0) (3904) Meditation and Infertility: A Bibliometric Analysis of Randomized Controlled Trials Rubens LC Tavares, MD, PhD1, Jane Guirado, MsC1 and Mariza Talim, MsC1 1Federal University of Minas Gerais, Belo Horizonte, Brazil Abstract Purpose: To perform a bibliometric analysis of randomized controlled trials (RCTs) about meditation and infertility in Web of Science database. Results: One hundred twenty-four articles were found. The 10 countries that most published this strategy were United States (32.2%), Australia (13.7%), England (12.1%), Netherlands (8%), China (7.2%), Sweden (6.4%), New Zealand (5.6%), Canada (4.8%), Germany (4.%), and France (4%). The main journals that have published were Cochrane Database of Systematic Reviews (11.2%), Fertility and Sterility (10.4%), Human Reproduction (4.8%), European Journal of Obstetrics Gynecology and Reproductive Biology (4%), Seminars in Reproductive Medicine (1.6%), Reproductive Biomedicine Online (1.6%), Obstetrical Gynecological Survey (1.6%), Journal of Obstetrics and Gynaecology (1.6%), Journal of Assisted Reproduction and Genetics (1.6%), and Human Reproduction Update (1.6%). The National Institutes of Health (USA) funded the largest number of projects. Conclusions: Few RCTs had addressed Meditation and infertility. United States, Australia, England, Netherlands, China, Sweden, New Zealand, Canada, Germany, and France are the main countries that have been producing this scientific knowledge and the National Institutes of Health (USA) has funded the largest number of projects. Financial Support: Faculdade de Medicina da Universidade Federal de Minas Gerais, Programa de Apoio à Pós-Graduaça∼o - PROAP - CAPES, Programa de Pós-Graduaça∼o em Saúde da Mulher, Programa de Pós-Graduaça∼o em Promoça∼o da Saúde e Prevença∼o da Violencia, Fundaça∼o de Amparo à Pesquisa do Estado de Minas Gerais - FAPEMIG, Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq. (3905) Effects of Mindfulness-based Stress Reduction on Functional Mobility and Quality of Life in a Patient Post Left Ventricular Assist Device Implantation: A Case Report Alexandra Flis, MD1 and Jennifer Chung Peck, DPT, ATC1 1Salt Lake City, Utah Abstract Purpose: To examine the feasibility of implementing a Mindfulness-Based Stress Reduction (MBSR) program in a patient in the intensive care unit after destination left ventricular assist device (LVAD) implantation. Results: MLHFQ improved 50% and FIM scores improved 75% at the end of the 12 week trial. Conclusions: Implementing a MBSR program post LVAD implantation may improve quality of life and functional outcomes. Further randomized controlled studies should be designed to explore this in more detail. (3906) Mimicking Prerenal and Intrinsic Acute Kidney Injury by Different Doses and Exposure Times of Cisplatin in Renal Proximal Tubular Cells and Both Recovery by Single Herbal Medicines via Activity of the Biomarkers HMGB1, NGAL, and KIM-1 Kyung-Soo Kim, MD, PhD1, Seung Hoon Lee, PhD2, Sung Man Oh, MS2, Dal-Seok Oh, OMd, PhD2, Chang-Seob Seo, PhD2, Hyeun-Kyoo Shin and OMd, PhD2 1Seoul St. Mary’s Hospital, Catholic University Graduate School of Medicine, Seoul, Republic of Korea 2Korea Institute of Oriental Medicine, Daejeon, Republic of Korea Abstract Purpose: Acute kidney injury (AKI) is an initial factor in kidney disorder cascades. Pre- and intrinsic (renal) AKI are frequent and have different therapeutic approaches. Recently, surrogate biomarkers on each AKI were developed; little is known about herbal medicine. Thus, this study aimed to investigate dose- and time-dependent effects of herbals to recover AKI in cisplatin-induced human kidney 2 (HK-2) cell line via high-mobility group box protein 1 (HMGB1), neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1). Results: Cisplatin of 10 μM decreased cell viability. Treatment with 400 µM of cisplatin reduced HMBG1 activity and lactate dehydrogenase release was observed. Longer exposure up to 48 h, NGAL and KIM-1 exhibited activity from 24 h onward. Additionally, NY showed over 50% change in all 3 biomarkers. Time-dependent profiles of 3 biomarker activities up to 48 h were different; HMGB1 exhibited a 7-fold change (6 h), and NGAL and KIM-1 exhibited 1.7-fold changes (24 h), respectively. For in vivo study, NY and PS showed over 50% reduction change of NGAL and KIM-1 activities. Conclusions: Two single herbal medicines, NY and PS, have potential on AKI due to inhibit activities of HMGB1, NGAL, and KIM-1 at AKI-mimicked condition. Furthermore, in vivo proof-of-concept study is needed for chronic kidney disorders. (3907) Fire Needle Acupuncture for Herpes Zoster: A Systematic Review and Meta-analysis of Randomized Clinical Trials Jian-ping Liu, PhD1, Li-yan Jia1, Bao-yong Lai1, Xiao-yi Yan1, Zhao-lan Liu, PhD1, Xiao Wang1 and Nanqi Zhao1 1Center for Evidence-based Chinese Medicine, Beijing, China Abstract Purpose: To evaluate the effect and safety of fire needle acupuncture for treatment of herpes zoster from randomized clinical trials (RCTs). Results: We included 22 RCTs with a total of 1611 participants. Only 1 RCT had low risk of bias and the other trials were of high risk of bias. Total effectiveness (the proportion of clinical recovery): fire needle acupuncture versus Chinese herbal medicine (RR1.10, 95% CI 1.03 to 1.17; n = 5); fire needle acupuncture versus antiviral agent (RR1.08, 95% CI 1.01–1.16; n = 3). Fire needle acupuncture relieved pain (VAS 0–10 cm) compared with Chinese herbal medicine (MD-1.20, 95% CI −2.02 to −0.39; n = 3), western medicine (MD-2.70, 95% CI −3.47 to − 1.93; n = 2). Using fire needle acupuncture shorten the skin lesion recovery time (day) compared with manual acupuncture: time of check blister (MD-1.38, 95% CI −1.97 to −0.79; n = 2), time of scab (MD-2.25, 95% CI −3.11 to −1.39; n = 2) time of herpes shed (MD-3.53, 95% CI −5.14 to −1.92; n = 2). The post neuralgia occurrence rate was lower with fire needle than western medicine or electro-acupuncture, but higher than manual acupuncture. There was no serious adverse effect reported from the trials. Conclusions: Fire needle acupuncture maybe effective in alleviating pain and shorten the skin lesion recovery time in patients with herpes zoster. However, due to general low methodological quality, further rigorous trials are needed. (3909) Qualitative Evaluation of a Whole-school Mindfulness Intervention at 2 Urban Public Schools Tamar Mendelson, PhD1, Ciara McAfee, BA2 and Angela E Lee-Winn, PhD1 1Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 2University of Texas at Austin, Austin, Texas Abstract Purpose: Children from disadvantaged urban neighborhoods disproportionately experience chronic stress and trauma, which negatively affects academic performance. Mindfulness programs have shown promise in improving youth social, emotional, and academic outcomes. Mindful Moment is a whole-school intervention developed by the Holistic Life Foundation that combines daily mindfulness practices, a cool-down room for coaching students in self-regulation, and teacher mindfulness training. We assessed perspectives of students, teachers, and principals on the Mindful Moment intervention at 2 urban public schools: 1 elementary and 1 high school. Results: Mindful Moment was well received by both teachers (83%) and students (90%). Across both schools, most students (86%) and teachers (96%) noted that the program enhanced student emotion regulation. Many teachers (74%) reported improvements in their own ability to manage stress. The program’s provision of additional supports was seen as a key strength. Participants at the larger school (high school), in which the program had not been implemented as long, noted more implementation challenges; recommendations for addressing these challenges included increased staff number and visibility, consistency of programming across students, and greater program variety. Conclusions: Positive program impacts were reported by principals, teachers, and students across both schools, particularly in the area of stress management. Findings also highlight aspects of program implementation critical for program success, which appear to differ based on school characteristics. (3910) Multidisciplinary Integrative Approach With Improved Clinical Outcomes in Patients With Chronic Pain Syndrome Ashima Shukla, MA, PhD1 and Ashutosh Shukla, MD, FACP1 1Artemis Hospitals, New Delhi, India Abstract Overview: Chronic pain is defined as pain present most of the time for a period of 3 months or more during the prior year. A multidisciplinary integrated approach was used in patients with chronic pain syndrome to integrate conventional treatment, cognitive behaviour therapy, physiotherapy, mind–body medicine and dietary advice. Patients were randomly allocated to 2 arms: in one arm patients received conventional treatment for chronic pain syndrome and in the other arm patients received integrated approach of management. McGill Pain Questionnaire was filled by all patients when they enrolled as well on the follow-ups to look for the result of intervention and for the comparison with the conventional treatment. The sample size of this study was 100 consecutive patients and the study design was comparative, qualitative and interventional study. Inclusion criteria were patients between 18 years and 70 years suffering from pain lasting for more than 3 months. Results from this study demonstrated that patients enrolled in the integrative medicine arm showed higher efficacy of pain relief compared to those in the conventional arm. Pain killer medications were withdrawn much earlier in patients in the integrative arm compared to those in the conventional arm. Rationale: Chronic pain is common in primary and tertiary care patients and is associated with distress, disability and increased health-care use. Pain is a multifactorial process that has both objective and subjective components. Chronic pain is complex and can manifest in multiple ways. This study highlights the importance of using multimodality treatments in an integrated system where in different specialists work in harmony for the welfare of the patient. Unfortunately, our current system of medicine with specialists working in silos is not effective for pain relief in patients with chronic pain syndrome. Objectives: To highlight the importance of using integrative medicine as a cost-effective tool in managing complex situations of patients with chronic pain syndrome. (3911) Integrative Medicine Program for Pain (IMPACT): An Innovative Transprofessional Non-pharmacologic System for Rehabilitating Chronic Non-cancer Pain Henri Roca, MD1 1Little Rock, Arkansas Abstract Overview: The Integrative Medicine Program for Pain (IMPACT) is an innovative comprehensive program designed to help individuals reengage with their mission, vision, and values within the existence of chronic pain. Impact operates exclusively from a health coaching perspective utilizing functional medicine, functional nutrition, acceptance and commitment therapy, movement and physical therapy using yogic methods, and auricular acupuncture. This primary program lead to a more intensive secondary program of enhanced offerings including Yoga, Culinary Arts, CBTi, Styles of Nutrition, Living Well with Pain, Relationships, Healing the Heart of the Warrior, and Home Evaluations. Services are offered exclusively to Veterans at the Central Arkansas Veterans Healthcare System. After discussion of the history and creation of this successful program, we will briefly discuss a best case series. Rationale: Nonpharmacologic approaches to addressing chronic pain have become a focus of care planning for pain. Models providing such care efficiently and effectively are lacking. The Central Arkansas Veterans Healthcare System has created a reproducible program to provide these services. Objectives: Participants will understand the benefits and challenges of changing the conversation surrounding care of chronic disease from one focused on the suppression of symptoms or treatment of the diagnosis to one that focuses on the enhancement of wellness and support of a fulfilling life; the significance of a singular method of communication within the electronic medical record surrounding patient’s valued actions directed toward wellness; and how a transprofessional team can come together to produce an integrated program for living well with chronic pain. (3912) Culture-based Neurological Differences in Response to Verum and Placebo Acupuncture to Prevent Radiation-induced Xerostomia Sarah Prinsloo, PhD1, David I Rosenthal, MD1, Y Shen, PhD2, MK Garcia, PhD1, Z Mung, MD2, Catherine Wu, BS2, W Bei, BS2, C Hu, BA2, Qi Wei, MA1, Mark Chambers, PhD1 and Lorenzo Cohen, PhD1 1Houston, Texas 2Fudan University, Shanghai, China Abstract Purpose: Differentiating verum acupuncture from placebo via neuroimaging has failed to produce a consistent pattern of activation of either acupuncture or placebo acupuncture. Here, we determine cultural differences in neural mechanisms for acupuncture to prevent xerostomia among head/neck cancer patients undergoing radiotherapy (XRT). Results: Brain activity profiles between verum and placebo conditions in China and the United States resulted in consistencies with published acupuncture research: (1) Alpha activity (8–12 HZ) decreased in the cingulate in the verum condition and increased in the placebo condition; (2) current source density decreased in the verum versus placebo condition in all predetermined regions of the brain including Brodmann areas 3, 6, 13, and 33. However, during the placebo condition in the United States, maximal activity was seen in BA 17 and 18 associated with perception of phenomenon. During placebo, the Chinese demonstrated maximal activity in areas associated with verum (BA 3, 4, 5 and 40, insula), and decreased activity in areas associated with perception. Conclusions: Chinese patients processed placebo in part as “verum acupuncture” but showed activity in the opposite direction than expected in verum—showing a different mechanism of placebo in the Chinese. Also, acupuncture may not have a “true” effect in perception of salivary production unless areas of perception reach a certain magnitude of activation. (3913) The Translational Potential of Celastrol, a Natural Triterpenoid, for Arthritis Therapy Kamal D Moudgil, MD, PhD1, Shivaprasad H Venkatesha, PhD1, Brian M Berman, MD1, Steven Dudics, BS2, Chun-Tao Che, PhD3 and Rakeshchandra R Meka, MS1 1University of Maryland School of Medicine, Baltimore, Maryland 2Baltimore, Maryland 3College of Pharmacy, University of Illinois, Chicago, Illinois Abstract Purpose: Rheumatoid arthritis (RA) is a multifactorial disease that involves both genetic and environmental components. Approximately 1% of the world’s population is afflicted with RA. Current treatments, including biologics such as anti-TNFα, are effective, but only in about 50% to 60% of RA patients. In addition, the use of biologics may render some RA patients vulnerable to infections. Therefore, there is an urgent need to identify and develop new therapeutic agents for RA. We tested celastrol, a triterpenoid derived from the traditional Chinese herb Celastrus aculeatus Merr, which possesses anti-inflammatory properties. Results: We observed a significant reduction in arthritic scores compared to controls. Moreover, key pro-inflammatory cytokines such as interleukin-1 (IL-1), IL-6, and IL-17 were decreased along with reduction in the T-cell response and antibodies to antigens relevant for disease pathogenesis. Also, assessed was the effect of celastrol on the relative frequency of T helper 17 and T regulatory cells in the draining lymphoid cells, and it was found to favor immune regulation. Conclusions: Our results demonstrate that celastrol administered via the oral route had beneficial anti-arthritic effect, as was also observed with intraperitoneal delivery. The added benefit to oral delivery is its translational capabilities, which will allow this work to eventually move from the bench to treating patients. (3919) The Evolution in the CAM Research in Colombia German D Benitez1, Eduardo H Beltran1 and Natalia S Aldana1 1Universidad Nacional de Colombia, Bogota, Colombia Abstract Purpose: To analyze the evolution of CAM (Complementary and Alternative Medicine and therapies related) research in Colombia, in the period 1980–2016, through a documentary review of the indexed literature, nonindexed academic literature, and gray literature and the revision of existing databases. Results: During the period 2011–2016, 568 investigations were carried out in the area of CAM compared to the period 1980–2010 in which the number of documents collected was 561. In other words, in just 6 years, the same amount of works that in the last 30 years. In total, 1146 documents were found, of which only 15% correspond to indexed literature, while 80% of the research work is academic. The object of study and the methods used are more in keeping with the classical research models. The themes with more production are Traditional Chinese Medicine with 32% and Homeopathy with 28% of the total. The main topics are chronic diseases, pain treatment, allergies, osteoarticular, respiratory and mental illness, and also CAM in public health. The most common research methods used was literature reviews, prospective observational studies, and retrospective case series. Conclusions: CAM’s research output in Colombia has increased exponentially over the past 20 years, but, in particular the last 10 years, the increase in works has been most associated with the creation of graduate programs in CAM. However, 85% of investigative efforts remain in institutional libraries and repositories and are not visible at the international level. It is recommended to strengthen research training in CAM, including teaching alternative forms of research and to encourage the publication of works at the indexed level and interinstitutional collaboration. (3921) Integrative Medicine Program Outpatient Meditation Group Classes at a Comprehensive Cancer Center: Analysis of Effects on Participant Self-reported Outcomes Alejandro Chaoul, PhD1, Gabriel Lopez, MD1, Lorenzo Cohen, PhD1, Qi Wei, MS1, Amy Spelman, PhD1, Rosalinda Engle, MS1 and Kathrin Milbury, PhD1 1Houston, Texas Abstract Purpose: Our integrative oncology program offers 3 different Tibetan meditation classes at no cost to patients and caregivers. We explore the effects of these classes on participant self-reported symptoms. Results: One hundred forty-two unique participants (76 patients and 66 caregivers) attended 1 or more classes (mean 1.84) from May to December 2015 (265 total attendance across all classes: PB n = 92; SS n = 87; MB n = 86). Most frequently reported symptoms at baseline for both patients and caregivers included well-being, sleep, and fatigue. Significant differences in symptom burden at baseline for patients versus caregivers included fatigue (2.72 vs 1.73), well-being (2.71 vs 1.75), pain (1.55 vs 0.8), and ESAS subscales of Physical health (9.04 vs 5.25) and Global distress (18.03 vs 11.17) (all P’s ≥ .05). There were no significant between meditation group differences in participant symptom burden at baseline or in symptom score reduction. Comparing class length (60 min vs 90 min), there were no statistically significant differences in symptom score reduction. For all meditation group classes, we observed a clinically significant improvement in fatigue (PB −1.2; SS −1.6; MB −1.2) and well-being (PB −1.7; SS −1.0; MB −1.2). Conclusions: A single meditation group class resulted in relief of multiple self-reported symptoms. Further research with a larger sample size is needed to better understand the symptoms that meditation can help control and how differences in meditation technique can affect outcomes. (3925) Public Health Through Integrative Complementary Traditional Health Practices Sivarama P Vinjamury, MD, MAOM, MPH1, Deborah Ndao, MPH2 and Beth Sommers, PhD, LAc3 1Southern California University of Health Sciences, Whittier, California 2Columbia University, New York, New York 3Boston University, Boston, Massachusetts Abstract Overview: Integrative Complementary Traditional Health Practices (ICTHP) comprises all the health-care practices that are not part of conventional medicine. In the last 3 decades, there is a growing interest in these practices in the United States. During this period, a special interest group on Alternative and Complementary Health Practices was started within the American Public Health Association, which grew into a huge section with 400 plus members and was renamed as Integrative Complementary and Traditional Health Practices Section. “The purpose of the ICTHP Section is to convene health professionals within the American Public Health Association (APHA) whose interests include any aspect of clinical care, research, teaching, advocacy, policy-making and health promotion related to integrative, complementary, and Traditional health practices, where we can pursue common goals and interests. The section envisions creating and participating in a global society where integrative health care and practice including wellness is a right, not a privilege. Our vision encompasses health promotion, disease prevention, and enhancement of well-being for all people.” This presentation will include the growth and development of this section. It will also discuss the methods and opportunities for multidisciplinary interaction and collaboration with organizations such as Academic Consortium for Integrative Medicine and Health that aim at promoting community and global health and develop evidence-based research. Rationale: Integrative medicine’s role within Public Health is not emphasized despite its main premise of prevention through natural methods is its goal. It is very appropriate to discuss about it in this conference. Objectives: To describe the growth and development of an Integrative Health Section within American Public Health Association. To discuss opportunities for collaboration between like-minded organization to establish integrative medicine and health practices to promote public health. (3929) The Experiences of Complementary and Alternative Medicine Practitioners in Providing Treatments With Controversial and Conflicting Proposed Mechanisms of Action Anne Majumdar Abstract Purpose: Acupuncturists and homeopaths in the United Kingdom are often statutory-regulated health professionals with biomedical training. The proposed mechanism of action of the complementary and alternative medicine therapy that they practice may considerably conflict with this conventional biomedical view. This study aimed to explore opinions and experiences of practitioners in rationalising and explaining their approach of working with these diverse approaches using a mixed methods approach. Results: Acupuncture participants with biomedical training reported using ‘Medical’ acupuncture and were less likely to explain effects of acupuncture on non-local effects and qi than non-biomedically trained acupuncturists. Biomedically trained homeopaths, on the other hand, agreed with non-biomedical colleagues that homeopathy was energy medicine to achieve vitality. Key themes identified from analysis of homeopathy interviews included triggering of self-healing mechanisms, importance of the consultation and indifference to medical colleagues’ attitudes towards their practice. Conclusions: Results of this study will inform the integration debate and highlight areas that warrant further study. (3930) North Cypriot Breast Cancer Patients’ Perspectives on Traditional Black Olive Oil Consumption and Diet, a Qualitative Study Anne Majumdar1 1▪▪ Abstract Purpose: The incidence of breast cancer (BC) in Northern Cyprus is higher than is seen internationally. There is little extant literature on the influence of diet on breast cancer recovery in Cyprus. Cypriot Black Olive Oil (BOO) is heavily consumed and differs from standard olive oil, which is a key component of the Mediterranean diet. The aim of this study was to explore breast cancer patients’ experiences and their perceptions of the dietary management of their breast cancer. Results: Fourteen participants (females aged 30–60 years) were interviewed. Key themes included coping with side effects, impact on emotional well-being, and self-consciousness. Others were physical impact on eating and confusion due to conflicting dietary advice. Some participants’ nutritional approaches were appropriate while others were not backed up by evidence or guidelines. A common theme was a reduction in carbohydrate intake, particularly sugar. Perceptions and habits regarding the consumption of BOO varied. Conclusions: Deeply affected by BC, participants were very concerned about diet and keen to try anything to recover. Some participants adopted very strict dietary changes. Results suggest that the BC patients would benefit from further dietary advice to prevent confusion. Further investigation into BOO would be useful. (3934) Stress Management and Resiliency Training for Health-care Professionals Michelle L Dossett, MD, PhD, MPH1 and Darshan Mehta, MD2 1Massachusetts General Hospital, Boston, Massachusetts 2Boston, Massachusetts Abstract Purpose: Burnout is epidemic among health-care professionals. Prior studies have suggested that resiliency training programs incorporating mind–body skills may reduce provider burnout. We examined the effects of a stress management and resiliency training (SMART) program developed for clinical populations and adapted it to health-care providers. Results: Participants attended an average of 6 of 8 sessions. There was a significant reduction in perceived stress (P = .001, Cohen’s d = 0.71) and significant improvement in global mental health (P = .018, Cohen’s d = 0.48) as well as nonsignificant trends toward improvement in physical health (Cohen’s d = 0.36) and job satisfaction (Cohen’s d = 0.30). All participants except for one agreed that the program was relevant to their life and that the skills taught were helpful. Qualitative analysis of free text responses revealed that participants developed greater presence with patients, ability to live in the moment, and empowerment to make positive life changes. Conclusions: Delivering the SMART Program to health-care professionals is feasible and may serve as a useful tool for increasing resilience to stress. Many participants found the program transformative and the majority felt they benefited from the skills learned. Additional groups are ongoing. (3935) A Spin on Ageing: The Effects of International Poi on Health Kate R van West1 1University of Auckland, Auckland, New Zealand Abstract Purpose: The purpose of this study was to measure the effects of International Poi (a weight on the end of a cord which is swung in circular patterns around the body), as compared to Tai Chi, on physical, cognitive, and emotional health in healthy older adults with an assessor-blind randomized controlled study. Results: Both interventions benefited postural stability (Functional Reach Test P = .008, 4-Stage Balance Test P = .003), upper limb strength (hand grip P = .0001), memory (composite memory P = .007, visual memory P = .004), and simple attention (P = .038). Tai Chi also benefited systolic blood pressure (P = .026). Qualitative analysis revealed participants in the International Poi group felt relaxed, challenged, and happy during the intervention. For Tai Chi; relaxed, calm, and peaceful. Conclusions: International Poi is as effective as Tai Chi for improving physical, cognitive, and emotional health in healthy older adults. (3936) The Feasibility and Efficacy of a Ketogenic Diet Intervention on Overweight and Obese Men Undergoing Active Surveillance for Prostate Cancer Mohummad M Siddiqui, MD1, Jason Bosley-Smith, MS, LDN, CNS1, Joseph Aryankalayil, BA1, Adeel Kaiser, MD1 and Christopher R D’Adamo, PhD2 1Baltimore, Maryland 2University of Maryland School of Medicine, Baltimore, Maryland Abstract Purpose: Many men with indolent forms of prostate cancer are managed expectantly using active surveillance (AS), with the goal of delaying treatment and associated toxicities. Elevated body mass index has been identified as an independent factor associated with increased risk of cancer progression during AS. The ketogenic diet is a promising intervention that is increasingly employed in integrative oncology. This clinical trial aims to gather preliminary data evaluating the effects of the ketogenic diet to delay cancer progression in overweight and obese prostate cancer patients undergoing AS. Results: Two of 12 patients have enrolled with full enrollment expected by early next year. The impact of the ketogenic diet on the prostate tissue microenvironment will be compared to matched controlled samples from 24 AS subjects meeting our study enrollment criteria but not undergoing the diet intervention. Conclusions: This trial represents the first prospective study examining the use of a ketogenic diet for prostate cancer patients on AS. We anticipate that the ketogenic diet will be a feasible strategy to elicit weight loss in our study population. The dietary impact on serum inflammatory and hormonal biomarkers, as well as associated changes in the prostate microenvironment, may help elucidate the mechanisms behind the benefit from weight loss and identify targets for future intervention. (3937) Integrative Proton Therapy: A Novel, Personalized Strategy Combining Precision Proton Treatment With Integrative Medicine Modalities to Improve Quality of Life and Outcomes for Cancer Patients Brian M Berman, MD1, Delia Chiaramonte, MD2, Adeel Kaiser, MD2, Charles B Simone II, MD, Griffin McMath, ND2 and William F Regine, MD2 1University of Maryland School of Medicine, Baltimore, Maryland 2Baltimore, Maryland Abstract Overview: Approximately 60% of cancer patients receive radiation therapy during their disease course. Conventional radiation techniques employ high energy X-rays that deposit cytotoxic energy along the entire path of the radiation beam, extending to the targeted tumor and beyond. Proton therapy (PT) is a highly focused form of radiation using charged particles that deposit most of their energy directly into a tumor volume and terminate at that location. This limits unnecessary radiation exposure to critical organs that may abut tumor tissues. PT requires a particle accelerator and is only available in a few U.S. facilities. However, with even the most advanced forms of cancer therapy, patients may still experience toxicities through direct tissue damage or the psychological impact of their disease. Prior studies using complementary modalities have demonstrated positive results concerning these domains with improved quality of life (QOL). Rationale: We will examine the impact of a novel treatment strategy employing advanced, precision radiation technology with a personalized wellness plan developed by a naturopathic doctor and implemented by an integrative health team. The wellness plan is formed prior to the initiation of proton therapy to identify baseline psychological, psychosocial, and/or nutritional deficiencies that may negatively impact the patient’s cancer care experience and post-treatment QOL. Targeted interventions based on this assessment include combinations of guided imagery, yoga nidra, acupuncture, massage, therapeutic art, yoga therapy, mind–body medicine, and educational sessions covering stress management, nutrition optimization, and supplement use. Objectives: To our knowledge, this newly launched cancer program is the first of its kind to fully integrate precision cancer therapy using proton technology with complementary modalities to maximize quality of life outcomes. We anticipate that this targeted approach will help to greatly reduce the negative impact of cancer therapies and will serve as a new model for the treatment of cancer patients. (3938) An Innovative Approach to Health Education: Utilizing an Ancestral, Integrative and Functional Medicine Education Resource With Students, Clinicians and Patients Robert D Abbott, MD1 1University of Virginia, Virginia Commonwealth University, Shenandoah Valley, Charlottesville, Virginia Abstract Overview: According to the World Health Organization, a health-care system involves “all the activities whose primary purpose is to promote, restore or maintain health” (The World Health Report 2000 – Health systems: improving performance). This broad definition encompasses health-care practitioners, health-care students and patients. In recent years, the Ancestral, Integrative and Functional Medicine movements have helped empower all 3 of these groups. The Institute for Functional Medicine defines Functional Medicine (FM) as a system that addresses the underlying causes of disease, using a system-oriented approach, engaging both patient and practitioner in a therapeutic partnership. The University of Arizona defines Integrative Medicine (IM) as healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies. Ancestral Health can broadly be described as an approach to health focused on optimizing lifestyle habits involving diet, sleep, social interaction, movement and spiritual engagement based on the evolutionary history of our ancestors as well as our more recent cultural relatives. An obstacle for all of these movements, however, is that the delivery of information and educational resources is dispersed over many different organizations and is often difficult to access and consume. Books, websites, videos, podcasts and even online-based trainings can be easily found on the Internet but not easily organized or vetted for relevance and applicability. This presentation highlights an electronic book resource that organizes Ancestral Health, IM and FM resources by learning style (auditory, visual and kinetic) and further categorizes the resources by level of expertise or intended audience. The goal of this educational resource is to provide individuals with a dynamically evolving, free repository of educational health resources that can streamline ancestral, IM, and FM education for practitioners, health-care students and patients. Rationale: Health education and its delivery are changing. Medical school costs are exceeding $200,000 and the demand for integrative and functional clinicians well versed in lifestyle and root-cause resolution approaches to health is outpacing the current supply. Many medical schools and residency programs still provide very little nutrition, lifestyle or integrative medicine education as part of their formal curricula. The majority of students are often unaware of ancestral, integrative, and functional approaches to wellness outside of their formal school training and are easily overwhelmed by the breadth of information provided as part of their formal education. Patients and laypersons too are not immune to the growing problem of information overload, as the coming generations will not be faced with the problem of going without, but rather, with the problem of having too much. Collectively, practitioners need educated and empowered patients and patients need educated and open-minded clinicians. We are a worldwide community needing change in order to promote health and need each other to thrive. This presentation highlights a dynamically evolving electronic book resource, a first attempt at synthesizing and consolidating some of the most relevant health education resources, so students, clinicians and patients do not have to search in vain for what can bring them joy and health. Objectives: The aim is to discuss the availability, utility and accessibility of educational resources with regard to an ancestral, functional and integrative approach to health; to provide a methodical and practical approach for exploring educational resources with regard to identified goals, intentions and cognitive/learning styles; to allow one to appreciate the need for broadening one’s approach and understanding of currently available educational resources including both those that are freely accessible and those available through formal trainings/certification programs; for clinicians, to empower them to expand their education into integrative, ancestral and functional medicine as well as to provide them with a framework to offer concise and individualized educational health resources/plans tailored to the individual interests, concerns and preferred learning style of their patients; for students, to provide them with a practical, complementary education plan to support their current academic endeavors, tailoring the experience to their available financial resources and preferred cognitive learning style; for patients, to provide them and their families with reliable and relevant educational resources, to empower them to utilize a variety of resources to aid in lifestyle and habit change, and to allow them to appreciate the need for collaboration with an experienced holistic clinician when necessary. (3950) A Case Report of Subacute – Phase Hypersensitivity Pneumonitis Treated With Korean Traditional Medicine So H Shim1, Kwon J Nam1, Jun Y Choi1 and Hee J Seo1 1Korean Medicine Hospital of Pusan National University, Yangsan, Republic of Korea Abstract Purpose: As the environmental pollution increases, the importance of allergic diseases has been emphasized. Among them, hypersensitivity pneumonitis is an allergic disease clinically causing dyspnea, cough and fever. However, diagnostic criteria and guidelines have not been clearly established and the studies are not actively conducted. In this study, we report a case of subacute – phase hypersensitivity pneumonitis patient, treated with Korean traditional medicine. Results: After about 2 weeks of treatment, the patient showed the marked improvement. Fever completely disappeared after 2 days of treatment. Dyspnea, the most uncomfortable symptoms, improved from third day of admission and was significantly reduced to G/A 3/10 level at the sixth day of admission. Cough also improved to similar levels by 2 days later. Besides, the accompanying symptoms such as discomfort of the throat, general weakness and myalgia were also improved. Conclusions: These results suggest that the Korean traditional medicine could be effective to regulate the hypersensitivity pneumonitis symptoms. (3952) Dialectical Pain Management Skills Group for Adults on Long-term Opioid Therapy: Feasibility and Preliminary Outcomes Deborah Barrett, PhD, LCSW1, Amanda Zaski, MSW1, Mark J Edlund, MD, PhD2 and Carrie Brintz, PhD1 1Chapel Hill, North Carolina 2RTI International, Durham, North Carolina Abstract Purpose: Chronic pain is often treated with opioids, which have limited effectiveness and significant side effects and risks. This study aimed to test the feasibility and preliminary effects of a novel intervention targeting emotional and physical distress associated with chronic pain. It was hypothesized that teaching skills to reduce distress may also reduce reliance on opioids. Results: Seventeen adults aged 28–75 years (71% female, 82% White) were enrolled. The majority identified multiple pain conditions (82%) and were taking 2 opioids (59%); 71% attended 6 or more sessions, with 18% withdrawing and 76% completing postassessments. From pre- to postintervention, significant improvements were found on the Chronic Pain Acceptance Questionnaire (Mean change = 15.77, P = .002) and PHQ-9 depression scores (Mean change = −3.85, P = .03); 38.5% of completers decreased their opioid dosage from baseline and 0% increased their dosage. In qualitative interviews, participants described high levels of satisfaction with the intervention and benefits from the skills. Conclusions: In adults taking daily opioid medications for chronic pain, a DPM group is feasible and may reduce depression, increase pain acceptance, and help reduce opioid reliance. An appropriately powered randomized controlled trial is needed to assess the intervention’s effectiveness and determine mediators and moderators of improvement. (3958) Shedding Light on the Relational Influences of Yoga On and Off the Mat Through Qualitative and Quantitative Methods Steriani Elavksy, PhD1, Scherezade K Mama, PhD2, Linda Larkey, PhD3 and Moé Kishida, PhD3 1University of Ostrava, Ostrava, Czech Republic 2The Pennsylvania State University, University Park, Pennsylvania 3Arizona State University, Phoenix, Arizona Abstract Purpose: The overarching aim of the present study was to utilize both qualitative and quantitative methods to better understand the potential influences of yoga on relational outcomes (i.e., connections with oneself and social relationships), which are invaluable for one’s health and well-being. Results: In the qualitative analyses, 4 emerging themes were identified (i.e., yoga generates calm states, mindfulness, (self)-compassion, and social connectedness) culminating in the development of a conceptual model of how yoga may work to bring about relational benefits. Pathways in the framework were then tested through a series of multilevel analyses which indicated that on days when an individual practiced more yoga than their usual, greater mindfulness (b = 2.93, SE = 0.39, P < .05) and self-compassion (b = 1.45, SE = 0.46, P < .05) were reported. 1-1-1 multilevel mediation models demonstrated yoga had an indirect effect on both compassion and social connectedness through increases in mindfulness at the within- and between-person levels. In models testing self-compassion as the mediator, the indirect effect of daily yoga practice on compassion was significant, although limited to the within-person level. Conclusions: Findings suggest a routine yoga practice appears to hold promise in having a positive impact (on and off the mat) on preserving and strengthening the intra- and interpersonal connections which constitute the building blocks of our day-to-day lives. (3960) Systematic Reviews and Meta-analyses on Effect of Ayurvedic Interventions for Hypercholesterolemia, Hypertension and Coronary Heart Disease Dinesh Gyawali, PhD1, Sridharan Ramaratnam, MD2, Robert Schneider, MD, FACC1 and David W Orme-Johnson, PhD1 1Maharishi University of Management, Fairfield, Iowa 2Apollo Hospitals, Chennai, Tamil Nadu, India Abstract Purpose: Heart disease is the number one cause of death globally. Due to increasing costs and numerous side effects of conventional medicine complementary healing approaches like Ayurveda are trending now. However, in lack of sufficient scientific evidence, safety and efficacy profile of these interventions has not yet been established. Systematic reviews and meta-analysis are the gold standard of evidence upon which clinicians and consumers rely. Till date, there are no Cochrane or any other systematic reviews on Ayurvedic interventions for cardiovascular risk factors. Hence, the current study was conducted with an aim to explore the efficacy of Ayurvedic interventions in hypercholesterolemia, hypertension and coronary heart diseases, identify the strength of evidence and any possible side effects. Results: Three meta-analyses of 64 studies on 2629 people studying effects of 10 different Ayurvedic interventions for hypercholesterolemia, high blood pressure and coronary heart disease, concluded that there is moderate to high strength evidence that several Ayurvedic herbal preparations are safe and effective. They pose no known side effects and thus can be used as dietary supplements or as an adjuvant to conventional therapy for better results. It was observed that Commiphora mukul (guggulu) reduced total cholesterol and low-density lipoprotein levels by approximately 16 mg/dL and 18 mg/dL, respectively, with high certainty evidence. Similarly, garlic and Terminalia arjuna (arjuna) based formulas also had high to moderate strength evidence of their efficacy to reduce cholesterol levels. On the other hand, Arjun Vachyadi compound and Rauwolfia serpentina based formulas were found to have moderate certainty evidence to reduce high blood pressure. It was also observed that Ayurvedic formulas with arjuna as a chief ingredient are capable of improving left ventricular ejection fraction by 12% with a moderate strength of evidence. Findings of these systematic reviews and meta-analysis encourage future researchers to conduct methodologically rigorous randomized clinical trials studies with a larger sample size. Conclusions: In conclusion, findings from 3 systematic reviews and meta-analysis suggested that Ayurvedic herbal medicine for hypercholesterolemia, hypertension and coronary heart disease do not pose any side effects and/or any serious drug interaction and thus can be used safely as supplements or as adjuvants to western medication. On an average, there is a moderate strength of evidence that these herbal medicines may reduce the cardiovascular risk factors within a range of 6% to 15%. However, more randomized controlled trials on bigger population are of utmost need to develop better confidence in the evidence found. (3961) A Case Report of Antibiotic-associated Diarrhea Treated With Traditional Korean Medicine Yoon-Jeong Seo1 1Kyung Hee University, Seoul, Republic of Korea Abstract Purpose: The aim of this clinical study is to describe the case of a patient with antibiotic-associated diarrhea, which was improved by treatment with herbal medicine. Results: During the treatment, the Bristol Stool Form Scale changed from type 7 to type 5. Conclusions: The results suggest that traditional Korean medicine may be an effective treatment for antibiotic-associated diarrhea. (3962) Utilization of Complementary and Integrative Medicine Among Lupus Patients: A Patient-centered Analysis of Perceived Effectiveness and Preference Lindsey A Warner, BS, MS1 and Shazia Beg, MD1 1University of Central Florida, Orlando, Florida Abstract Purpose: The aim of this study is to ascertain the use, preference, motivation and perceived effectiveness of Complementary and Integrative Medicine (CIM) in individuals with systemic lupus erythematous. We hope that this data will be informative for physicians caring for individuals with lupus to the prevalence of CIM use and perceived effectiveness in this population so that they may better advise their patients on safety. We also hope to encourage further research into the most prevalently used modalities to both promote patient safety and to suggest novel therapies to help increase quality of life for individuals with this poorly controlled condition. Results: The 3 CIM therapies most commonly used among our lupus sample were non-herbal natural products (44; 57%), aromatherapy/essential oils (32; 41.5%) and meditation (31; 40.2%). Non-herbal natural products include chondroitin, coenzyme Q 10, fish oil, omega 3 and docosahexaenoic acid (DHA), glucosamine, lutein, melatonin, methylsulfonylmethane, and sesame oil. The most commonly utilized were natural fats (40; 90.9%) which includes fish oil, omega 3 and DHA. This was followed by melatonin (13; 29.5%) and glucosamine (11; 25 %). Despite their high rate of utilization, over a third of participants (17; 38.6%) felt that they were not effective or only somewhat effective. Similarly (14; 43.8%) of the aroma therapy users found it not effective or only somewhat effective. However, 67.7% (21) of the meditation users found their therapy to be effective, very effective or extremely effective. The most commonly used essential oil was lavender (11; 36.7%) followed by peppermint (3; 10.0%). The majority of respondents in all 3 groups indicated that their motivation for utilizing these therapies was because ‘they believed it worked’ and when asked about their desired benefit indicated ‘general wellness’. This was a common theme for and was reported as the motivation and benefit for 10 of the 19 therapies. The most striking deviation from this theme however was herbal medicine, with (22; 84.6%) reporting motivation was relief of a lupus related symptom; 91.7% of the 26 respondents that utilized herbs did so specifically to alleviate lupus-related symptoms rather than general wellness, with 20 (76.9%) reporting benefit. Of the 20 herbs listed, turmeric (7; 26.9%), marijuana (6; 23.0%) and green tea (2; 7.6%) were reported to be most beneficial for lupus-related symptoms. Discussion/Conclusions: The rate of CIM utilization reported by our sample was 87.6%, which is approximately 3 times higher than the 2012 National Health Statistic Reports estimated average of 33.2% for the general U.S. population. The 3 most commonly used modalities among our participants, non-herbal natural products (57%), aromatherapy (41.5%) and meditation (40.2%), differed from the nationally reported top 3, which were non-herbal natural products (17.7%), meditation (10.9%) and yoga (10.1%). With a disorder as poorly controlled as lupus, any therapy that increases quality of life warrants consideration regardless of how unconventional. Meditation, herbal medicine and massage were particularly promising, as over one third of the sample had utilized them with over 60% of participants reporting benefit. (3963) Effectiveness of a Mind–Body and Peer Support Program for Teens Living With Chronic Illness and Their Parents: A Pilot Study Brittany Blockman, MD1, Michael Acree, PhD1, David Becker, MD, MPH1, Audrey Nichols, RN1, Arielle Schaffer-White, MD1, Megan Winkelman, MA1, Judith T Moskowitz, PhD1 and Frederick M Hecht, MD1 1San Francisco, California Abstract Purpose: To assess the feasibility of a novel group intervention providing mind–body skills and peer support for teens living with chronic illness and their parents and explore its impact on physical and mental health, resiliency, and symptoms. Results: Teens (N = 26) were 73% female, average age 15.5 years, average attendance 7.8 sessions. Illnesses represented: cancer, chronic abdominal pain, chronic migraine, cystic fibrosis, endometriosis, inflammatory bowel disease, juvenile idiopathic arthritis, lung disease, neuromuscular disorders, type 1 diabetes mellitus, Wegener’s granulomatosis. Comparing baseline with immediate postintervention, multiple outcomes showed statistically significant improvements: physical health (NIH Promis) mean change (MC) = +0.92, Effect Size (ES) = 0.45, P = .036; Mental Health (NIH Promis), MC = +2.46, ES = 0.83, P = .005; Total Mood Disturbance (Profile of Mood States—POMS), MC = −1.37, ES = 0.51, P = .021; Depression (POMS), MC = −0.39, ES = −0.52, P = .018; Fatigue (POMS), MC = −0.028, ES = 0.52, P = .011; Vigor (POMS), MC = +0.30, ES = 0.49, P = .003; Perceived Stress (Perceived Stress Scale), MC = −3.72, ES = −0.79, P = .001; Resiliency MC = +0.36, ES = 0.73, P = .002; Posttraumatic Growth MC = +0.39, ES = 0.54, P = .015. All results retained significance 3 months postintervention, except posttraumatic growth, and ES for anxiety (POMS) became significant at this point (ES = −0.89, P = .003). Teens also reported decreases in symptom frequency (P = .001) and medication usage (.002), when comparing baseline to immediately post-intervention. Parents reported a decrease from baseline in unplanned doctor visits for their child at the 3-month follow-up (P = .034). The majority of these results become stronger in an analysis that retained only participants attending ≥50% of the sessions (n = 22). Conclusions: Our results suggest that the intervention resulted in positive changes in physical health, mental health, mood, stress, resiliency, and posttraumatic growth in teens living with chronic illness; these promising results warrant further testing in a controlled trial design. (3964) Barriers to Access and Perceptions of Massage Therapy at a Public Hospital System in Northeast Ohio Earl Pike, BA1, Diane Mastnardo, BS2, Jacqueline Dolata, MBA1 and John D Thornton, MD1 1 MetroHealth Medical Center Case Center for Reducing Health Disparities, Cleveland, Ohio 2 Massage of Northern Ohio Practice Based Research Network/MetroHealth Case W, Cleveland, Ohio Abstract Purpose: To identify perceptions and barriers to access of massage therapy utilization among patients receiving care in a public hospital system. Results: Massage was seen as health care equal to luxury and not viewed as dirty or inappropriate. Respondents from urban clinics were less likely to have had a massage by a licensed massage therapist. Cost is overwhelmingly the largest barrier in both urban and suburban settings. Patients identified back pain, headaches, stress, and anxiety as reasons they would seek massage. Conclusions: Dispelling myths and increasing understanding about the benefits of massage as a treatment option will be necessary for inclusion in health centers. Providing licensed massage therapist as a billable provider would help make massage therapy a more viable option for those of lower socioeconomic status, as cost was overwhelmingly seen as the largest barrier to access. With today’s opioid epidemic, massage therapy may be a viable alternative to prescription opioids for pain. (3965) Resilient Residency: Creating a Culture of Interdisciplinary, Interprofessional Support Through a Multimodal Integrative Intervention Terri Menser, PhD, MBA1, Nikol Marchenko, BS2, Scott Holliday, MD3 and Maryanna D Klatt, PhD2 1Houston Methodist Research Institute, Houston, Texas 2The Ohio State University, College of Medicine, Columbus, Ohio 3Columbus, Ohio Abstract Purpose: This novel and practice changing research shows that Mindfulness in Motion, a multimodal intervention, delivered during the workday significantly reduced burnout, increased resilience and vigor toward work for a group of interdisciplinary residents. Our team expanded a Graduate Medical Education pilot to target interprofessional, institutional resiliency within our academic health center by bringing together residents, chaplaincy residents, attending physicians, medical center faculty, and hospital administrative/clinical staff. Results: The first cohort (n = 23) demonstrated a significant 22% reduction in burnout, while increasing in resilience, across programs. By intervention end, there was a significant decrease in the depersonalization score (P = .0442), and in the emotional exhaustion (P = .388) Maslach Burnout Inventory subscale compared to baseline. In addition, the pre/post score for resilience, (Children’s Depression Rating Scale-Revised) significantly increased (P = .0204), while there was a significant increase for the vigor subscale (P = .0042) of the Utrecht Work Engagement Scale. Conclusions: A hybrid (in-person and online) mindfulness intervention administered can lead to significant improvements in burnout, specifically depersonalization, emotional exhaustion, resilience, and work engagement, more specifically, vigor. The Graduate Medical Education office used Accreditation Council for Graduate Medical Education common program requirements around well-being to extend beyond our 800+ resident physicians, recognizing that health care as an interprofessional team endeavor, with each member of any health-care team impacting the other. Future expansion will be interprofessional, as well as interdisciplinary across residencies. (3968) Preliminary Findings for a Wellness Program for Veterans With Post-traumatic Stress Disorder Barbara L Niles, PhD1, DeAnna L Mori, PhD2, Elizabeth Weinstein, BA1, Anica P Kaiser, PhD1, Katharine Smidt, PhD1 and Laurel Brown, PhD3 1Behavioral Science Division, National Center for PTSD, Boston, Massachusetts 2Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts 3Boston, Massachusetts Abstract Purpose: The Veterans Administration Whole Health Initiative promotes a model of care where Veterans play a central role in managing their health and well-being in partnership with their health-care team. A key component is learning mindfulness skills that help Veterans make choices about their health with the goal of enhancing their overall well-being. This approach may be particularly helpful for Veterans with post-traumatic stress disorder (PTSD) who are at increased risk for health problems. Focusing on healthy behaviors that promote improved wellness may interrupt the progression of disease and disability associated with PTSD. In addition, mindfulness training may reduce hyperarousal symptoms that have been identified as prominent in the development and maintenance of PTSD. Results: Both interview data and responses on the Client Satisfaction Questionnaire indicated high satisfaction with the program (M = 29.56 of possible 32). In addition, the mean attendance rate was high (76.9%) with only one no-show and no dropouts. Themes identified through the qualitative interview data suggested that the group motivated participants to make healthy behavior changes and taught skills that helped them cope with their symptoms of PTSD. Conclusions: The preliminary results indicated that this Wellness intervention was well attended with high rates of satisfaction. This Wellness approach may offer an alternative or supplementary treatment for PTSD that is highly acceptable and may improve health behaviors. (3970) Stakeholder Expectations of Integrating a Doctor of Chiropractic Into a Rehabilitation Specialty Hospital: A Qualitative Analysis Zacariah K Shannon, DC, MS1, William C Cooley, MD2, Stacie A Salsbury, RN, PhD1, Robert D Vining, DC1 and Christine M Goertz, DC, PhD1 1Palmer College of Chiropractic, Davenport, Iowa 2Dartmouth Medical School, Hanover, New Hampshire Abstract Purpose: Incorporating new disciplines into integrative settings can introduce novel perspectives on care and additional challenges in terms of establishing logistics and defining treatment roles. This qualitative research project explored stakeholder expectations of adding a doctor of chiropractic (DC) to the health-care team at a rehabilitation specialty hospital. Results: The overall goal of the hospital was to progress patients toward discharge, often through an extended, incremental process that involved interdisciplinary collaboration to form personalized treatment strategies. Stakeholders most commonly expected that chiropractic care would benefit patients directly by affecting pain and physical function, which were thought to improve upper/lower extremity function and advance self-care activities of daily living, including wheelchair use and transfers. Stakeholders also expected indirect effects of chiropractic care to impact the work of other providers and the overall hospital mission. For example, a reduction in pain and resulting behaviors was expected to increase patient cooperation and performance with other providers’ treatments. Expectation themes were consistent across stakeholder groups with emphasis of patients on ambulation, family on quality of life, medical providers on medication use, therapists on muscle tone, and nurses on pain-related behaviors. Conclusions: Expectations for the DC emphasized pain management and physical function placed within the context of incremental progress culminating in eventual discharge. Understanding expectations can benefit both the new practitioner and current stakeholders, serving to illuminate the reasonableness of expectations and as an anchor point for future evaluation of success. (3973) “Placebo Effect is Probably What We Refer to as Patient Healing Power”: A Qualitative Pilot Study Examining How Norwegian Complementary Therapists Reflect on Their Practice Trine Stub, PhD1, Nina Foss, PhD2 and Ingrid Liodden, PhD3 1The National Research Center in Complementary and Alternative Medicine, Tromso, Norway 2UiT, The Artic University of Norway, NAFKAM, Tromso, Norway 3Oslo and Akershus University College of Applied Sciences, Oslo, Norway Abstract Purpose/Background: Complementary therapists spend considerable time with their patients, especially in the first consultation. The communication between patients and their therapists is important for raising consciousness and activation of the patient’s self-healing power. Thus, the aims in this study were to delineate what complementary therapists regard as essential in patient consultations, their view of the healing process, and how the therapists understand the placebo effect and its position in the healing process. Results: The pilot study showed that the implemented methods seems feasible and fit well with the aims of this study. Complementary therapists (chiropractor, naprapath [musculoskeletal therapist], acupuncturist, and acupuncturist/homeopath) representing 4 different complementary modalities participated. A combination of the conversation and examination during the first consultation formed the basis for the therapist’s choice of treatment. A successful consultation was characterized by a fruitful relationship between the therapist and the patient. Moreover, the therapist needs to be humble and show the patient respect. Patients’ positive beliefs and expectations about the treatment play a significant role in the healing process. The more hope the therapist can bring about, the more easily the patient can start believing that it is possible to get well. Conclusion: This was a pilot study. Therefore, the findings should be appreciated as limited and preliminary. Therapists’ and patients’ mutual understanding and treatment goals were essential for a successful consultation. The therapists emphasized their professional skills and therapeutic competence as important when building fruitful relationships with their patients. Exerting authority and making the patient feel confident were essential factors for a successful healing process. The complementary therapists understood the placebo effect as the patient’s self-healing power, resulting from establishing trust and belief in the treatment process. (3976) Use of the MyStrength+MyHealth App to Identify Strengths, Challenges, and Needs for a Whole-person Personalized Approach to Care for Women With Circulation-related Problems Robin Austin, DNP, DC, RN-BC1, Karen A Monsen, PhD, RN, FAAN2 and Ruth Lindquist, PhD, ACNS, RN, FAAN2 1University of Minnesota, School of Nursing, Minneapolis, Minnesota 2Minneapolis, Minnesota Abstract Purpose: Cardiovascular disease is a leading cause of death in women. In cardiac care management, women’s voices are often underrepresented, and women have experienced being seen “as the disease” rather than as a whole-person with positive attributes as in addition to their physical challenges. Current methods are lacking to better understand a whole-person perspective to include strengths, challenges, and needs; and to provide interventions using a strengths-based approach. Strengths are defined as assets, skills, and talents in each family member, team member, family as a whole, and the community. A strengths-based approach offers a person-centered approach to address problems and to leverage each person’s unique strengths to support physical, emotional, and psychosocial well-being. A consumer-facing application, MyStrengths + MyHealth app, was developed to enable self-report of strengths, challenges, and needs using a consumer-facing version of the Omaha System, a multidisciplinary standardized health terminology. Results: For the entire sample, there were significant correlations between strengths, challenges, and needs (P < .01). Compared to women without self-reported circulation-related problems, women with circulation-related problems reported more strengths (M = 20.3; SD = 12.6 vs M = 19; SD = 14.5; P = .5); challenges (M = 14.5; SD = 9.7 vs M = 5.6; SD = 5.6; P < .0001); and health needs (M = 2.4; SD = 5.6 vs M = 1.1; SD = 2.9; P = .07). Conclusions: The MyStrengths + MyHealth app allows for standardized person-generated data to include both problems and strengths. This may provide insight into previously excluded or hidden data and potentially reveal new findings important for patients, caregivers, and health-care teams. Our long-term goal is to incorporate a strengths-based approach into health care through embedding a standardized holistic assessment and care planning process within electronic health record platforms, beginning with the patient voice. (3978) Advances in Integrative Medicine Policies in Brazilian Public Health System and the Parallel With the Actual National Medical Curriculum Thais S Araujo, MD1, Aarão C Dias dos Santos, MD2 and Idê G Dantas Gurgel, MD, PhD2 1Universidade Federal de Minas Gerais, Belo Horizonte, Brazil 2Fiocruz, Recife, Brazil Abstract Purpose: Brazil has a publicly funded health-care system called the Sistema Único de Saúde (SUS, Unified Health System), which 72% of the nation’s physicians practice within. In 2006, SUS initiated a National Policy for Integrative and Complimentary Practices (PNPIC) and since then is expanding integrative medicine (IM) services offered to the population. Despite these initiatives, it is unclear if there have been systemic changes in the public medical schools’ curricula to include IM topics. The purpose of this project is to review national IM initiatives through PNPIC, including their definitions, actions, and regulation; and to review the national curriculum guidelines and current curriculum at medical schools. Results: The Brazilian ministry of health has included in the PNPIC 17 complementary and alternative practices (CAM) that can be offered by the SUS. There are currently no national curricular medical school guidelines focused on IM. None of the largest 10 medical school’s websites reviewed mentioned IM or CAM in their core curriculum. Only 2 offered an elective in IM, both focused on acupuncture and homeopathy. Conclusions: This study supports that there is a disconnect between the SUS’s PNPIC initiative and the national graduate medical curriculum on IM. The results suggest that many graduating physicians will have limited teaching in IM and may be unprepared to work within SUS. Further evaluation is warranted to conduct a more comprehensive national curricular needs assessment to determine baseline amount of graduate medical training in IM and CAM and to update the national curricular medical school guidelines to address this need. (3980) Effects of Tai Chi on Stress and Cardiovascular Function in Patients With Coronary Heart Disease and/or Hypertension: A Randomized Controlled Trial Xufang Wu, MMed1, Nan Gu, MMed2, Wenyuan Li, MMed3, Yuyi Wang, MMed4, Jianping Liu, PhD, MD3, Alan Bensoussan, PhD5, Hosen Kiat, MBBS5,6,7, Paul Fahey, Nerida MMedStat5, Dennis Klupp, PhD5, Guoyan Chang, PhD5 and Yang, PhD5 1Changying Community Health Service Center, Beijing, China 2Dougezhuang Community Health Service Center, Beijing, China 3Beijing University of Chinese Medicine, Beijing, China 4Chongqing Hospital of Chinese Medicine, Beijing, China 5Western Sydney University, Sydney, Australia 6University of New South Wales, Sydney, Australia 7Macquarie University, Sydney, Australia Abstract Purpose: To investigate the effects of Tai Chi on stress and cardiovascular function in patients with coronary heart disease and/or hypertension. Results: Of 120 randomized participants (mean age, 64.3 years), 102 (85.0%) completed the trial. Using a linear mixed model, the Tai Chi group demonstrated a significant reduction in PSS-10 scores at week 24 (Mean, 10.44; 95% confidence interval (CI), 8.86–12.03) compared with the waitlist group (Mean, 11.71; 95% CI, 10.01–13.34) (P = .009). The mean walking distance during 6-min walk increased from 494.77 meters at baseline to 552.81 meters at 24 weeks in the Tai Chi group, while from 518.83 to 519.63 meters in the waitlist group. The difference between the 2 groups is statistically significant (P < .001). Significant differences were also detected between the 2 groups in depression, diastolic blood pressure, and quality of life. No adverse events related to Tai Chi were reported. Conclusions: A 24-week standardized Tai Chi intervention resulted in modest but statistically significant improvements in stress, fitness, depression, diastolic pressure, and quality of life, in patients with coronary heart disease and/or hypertension compared with those in the waitlist control group. (3982) Synergistic Effect of Dietary Delta-tocotrienol and Geranylgeraniol on Bone Properties in Obese C57BL/6 J Mice With Obesity-associated Type 2 Diabetes Mellitus Chwan-Li Shen, PhD1, Michael D Tomison, BS2, Gurvinder Kaur, PhD2, Latha Ramalingam, PhD3, Eunhee Chung, PhD4, Naima Moustaid-Moussa, PhD3 and Jannette Dufour, PhD2 1Lubbock, Texas 2Texas Tech University Health Sciences Center, Lubbock, Texas 3Texas Tech University, Lubbock, Texas 4University of Texas at San Antonio, San Antonio, San Antonio, Texas Abstract Purpose: Type 2 diabetes mellitus (T2DM) is a risk factor for osteoporosis and current diabetic therapies have potential adverse effects on bone metabolism. We previously reported that individual dietary bioactive components, delta-tocotrienol (d-TT, extracted from annatto) and geranylgeraniol (GG) benefit bone health by improving glucose homeostasis. In this study, we further investigated d-TT and GG for their possible synergistic effects on bone protection in a T2DM mouse model. Results: Both d-TT and GG significantly increased glucose clearance and improved insulin sensitivity, while no interaction (d-TT x GG) was observed. Neither d-TT nor GG affected serum insulin or pancreas insulin levels. In terms of serum bone markers, there was a significant interaction in procollagen I intact N-terminal propeptide (P1NP-bone formation marker) and collagen type 1 cross-linked C-telopeptide (CTX-bone resorption marker), resulting in d-TT + GG having the highest concentration of P1NP. The order of CTX levels was control > d-TT = GG = d-TT + GG. MicroCT analysis revealed that only d-TT supplementation, not GG, increased cortical thickness and decreased bone marrow volume/tissue volume at mid-shaft femur (P < .05). On the other hand, only GG supplementation was shown to (i) increase bone volume/tissue volume, trabecular number, and connectivity density; and (ii) decrease trabecular separation and structure model index at the cancellous bone of both femur and lumbar vertebrae-4. There was a significant interaction in femoral trabecular thickness with a result of d-TTxGG group having the highest value of trabecular thickness. Conclusions: Our results suggest that d-TT and GG have a synergistic effect on bone protection in obese T2D mice independent of improving glucose homeostasis. (3985) A Randomized Trial of a Group-based Therapeutic Yoga Program for Urinary Incontinence in Older Ambulatory Women Alison Huang, MD1, Amy Hsu, MD2, Michael Schembri, BS1, Leslee Subak, MD1, Nadra E Lisha, PhD1 and Margaret A Chesney, PhD1 1San Francisco, California 2Palo Alto Medical Foundation, Palo Alto, California Abstract Purpose: Purpose: To evaluate the feasibility, tolerability, and preliminary efficacy of a group-based therapeutic yoga program for urinary incontinence (UI) in older ambulatory women. Results: Results: Over 18 months, 56 women were randomized, 28 to yoga, 28 to control. Mean age was 65 ± 8 (range 55−83) years; 35% were ethnic minorities. Mean baseline UI frequency was 24 (±14) episodes/week. Fifty women completed the trial (89%), with 27 in the yoga and 23 in the control group. Of those, 75% attended >90% of group classes, and 88% completed >90% of home practice hours. Over 3 months, total UI frequency decreased by a mean of 19.3 ± 10.2 episodes/week in the yoga versus 11.2 ± 17.9 episodes/week in the control group (P = .02 for between-group difference in percent UI reduction from baseline; P = .09 for between-group difference in absolute UI reduction, after imputation for missing data). No women reported any adverse events related to either intervention. Conclusions: Conclusions: Findings demonstrate the feasibility of recruiting and retaining ambulatory incontinent women across the aging spectrum into a 3-month therapeutic yoga program and provide strong preliminary evidence to support efficacy in reducing UI frequency. When taught in a standardized way and with appropriate attention to safety, yoga may offer a promising community-based self-management strategy for UI among older women. (3987) Classroom-based Mindfulness for Stress Reduction in High School Students Jeanette Johnstone, PhD1, Joel Nigg, PhD2, Amanda Ribbers, MS2, Rachel Atchley, PhD2, Hanna Gustafsson, PhD2, Jessica Tipsord, PhD2 and Barry Oken, MD, PhD2 1National University of Natural Medicine, Portland, Oregon 2Portland, Oregon Abstract Purpose: Given the high degree of stress experienced by many high school students, this study sought to examine whether mindfulness was an acceptable classroom-based stress reduction intervention and whether it offered improvement in mood, anxiety and stress, as measured by self-reports and physiological measures. Results: Full data were available from 9 classes (n = 202 students). Post-intervention satisfaction for mindfulness withstood baseline expectancy effects (P < .001), while wellness satisfaction was positively correlated with pre-intervention expectations, r = .33, n = 39, P = .03. Post-intervention anxiety scores were significantly lower in students receiving mindfulness compared to usual health class (β = −.07, SE = .03, P = .009); no significant differences were found in other primary outcomes. Fifty-two percent of students (n = 35) used the mindfulness app once to practice outside of class; of those 10% used it 10 or more times. Conclusions: Wellness satisfaction was influenced by pre-intervention expectations. Offering mindfulness during the high school day was acceptable to students, but less than 10% met the expectation to use the mindfulness app to practice regularly outside of the classroom. Although anxiety improved, 8 weeks of classroom-based mindfulness, without outside practice, did not appear to be a sufficient “dose” to detect significant improvements in mood and stress in self-reports and physiological measures of lab-induced stress. These findings address some of the questions about the delivery of mindfulness in a classroom-based situation and suggest lifestyle elements that contribute to an active control for future comparative mindfulness research. CTN: NCT02629016. (3989) Herbal Medicines for Prevention of Anti-tuberculosis Drug-induced Hepatotoxicity: A Systematic Review of Randomized Controlled Trials Jian-Hua Wang, PhD1, Yuan Chi1, Merlin Willcox, DPhil, MRCGP2, Jian-ping Liu, MD, PhD3, Mei Wang, PhD1 and Xiu Dong, PhD1 1Liaoning University of Traditional Chinese Medicine, Shenyang, China 2University of Southampton, Southampton, UK 3Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: Herbal medicines are widely used for liver protection along with anti-tuberculosis treatment in China. This systematic review aims to evaluate the effectiveness and safety of herbal medicine for prevention of anti-tuberculosis drug-induced hepatotoxicity (ATDH) so to inform current policy and practice. Results: In total, 35 randomized trials involving 9552 participants who received anti-tuberculosis treatment were included. The commonly used herbal medicines were Silibinin (7/35), Hugan Pian (4/35), Dangfei Liganning (4/35), Fufang Yiganling (4/35), and Compound glycyrrhizin (3/35). Meta-analysis of low-grade evidence showed Silibinin reduced incidence of ATDH compared with no intervention (RR 0.25, 95% CI 0.14 to 0.43; 5 trials), and with Inosine (RR: 0.29, 95% CI: 0.16 to 0.52; 2 trials). Compared with Gluconolactone, Hugan Pian and Fufang Yiganling showed beneficial effect of ATDH rate (RR: 0.32, 95% CI: 0.17 to 0.62; 2 trials, and 0.46, 95% CI: 0.32 to 0.66; 3 trials, respectively). Meta-analysis showed that there was no significant difference between Fufang Yiganling and Gluconolactone for serum ALT levels (U/L) (MD −1.79, 95% CI: −3.99 to 7.56, I2 = 79%, 4 trials); however, positive effect was found for decreasing serum AST levels (U/L) (MD −15.73, 95% CI: −30.78 to −0.67, I2 = 98%, 4 trials). No serious adverse events were reported in relation to herbal medicine. Conclusions: Low-quality evidence shows prophylactic liver protection effect from some herbal medicines for ATDH. Further rigorous studies are needed to confirm the beneficial effect and safety of those potential herbal medicines for ATDH. (3993) Paediatrics and Gerontology Specialisations in the Complementary and Integrative Medicine Workforce: Characteristics of Practitioners Brenda Leung, PhD1, 2, Helene Diezel, MHSc3, Janet Schloss, PhD3, David Sibbritt, PhD4, Jon Wardle, PhD, ND4, Jon Adams, PhD4, Hope M Foley, BHSc3, 4, Matthew J Leach, PhD5 and Amie Steel, PhD, ND3, 6 1University of Lethbridge, Lethbridge, Alberta, Canada 2University of Technology Sydney, Calgary, Alberta, Canada 3Endeavour College of Natural Health, Brisbane, Australia 4University of Technology Sydney, Sydney, Australia 5University of South Australia, Adelaide, Australia 6University of Technology Sydney, Brisbane, Australia Abstract Purpose: Individuals frequently visit complementary and integrative medicine (CIM) practitioners to access specialised care during specific life-stages, including for support through paediatric and gerontology related challenges. The nature of specialisation amongst CIM practitioners in the Australian workforce has not previously been explored. This study examines rates of specialisation in paediatrics and gerontology amongst CIM practitioners within a representative sample of the Australian CIM workforce, and describes characteristics of practitioners with special interests in these 2 fields. Results: One thousand three hundred six practitioners completed the survey. Paediatrics and gerontology were the least frequently reported special interests in the sample. 30.1% of respondents indicated special interest in paediatrics and 19.3% in gerontology. Practitioners specialising in paediatrics were most likely to practice homeopathy (OR: 4.3, P ≤ .001), Chinese herbal medicine (OR: 2.5, P ≤ .001) or naturopathy (OR: 2.1, P ≤ .001). Practitioners specialising in gerontology were most likely to practice homeopathy (OR: 2.6, P ≤ .001), in non-urban localities (OR: 1.6, P = .002), and to have been practicing 15 + years (OR: 1.7, P = .021). Conclusions: While perceptions of homeopathy being safe may be influencing the specialisation of homeopaths in these vulnerable populations, there is much debate about the modality’s efficacy, calling for greater research in paediatric and gerontological homeopathy. Additionally, concerns surrounding quality and contamination of Chinese herbal products require attention, particularly in the paediatric population. The CIM practitioner workforce shows less interest in gerontology than other specialisations. In light of the ageing population in many countries, CIM practitioners should consider increasing support for this demographic. (3997) Non-specific Effects of Acupuncture and Sham Acupuncture in Clinical Trials From the Patient’s Perspective: A Systematic Review of Qualitative Evidence Justin CY Wu, MD1, Samuel YS Wong, MD1, Vincent CH Chung, PhD1, Robin ST Ho, MPH1 and Charlene HL Wong, BSc1 1The Chinese University of Hong Kong, Sha Tin, Hong Kong, Hong Kong Abstract Purpose: Previous clinical trials have demonstrated that both acupuncture and sham acupuncture exert significant, non-specific effects on treatment outcomes when compared to no-treatment controls. Recently developed framework (mechanisms in orthodox and complementary and alternative medicine [MOCAM]) suggests non-specific effects of acupuncture originate from multiple domains (eg, patient characteristics, acupuncturist skill/technique, patient-acupuncturist relationship, and acupuncture environment). However, it remains to be determined precisely how these domains influence non-specific effects of treatment among patients receiving acupuncture and sham acupuncture in clinical trials. Therefore, we conducted a systematic review (SR) to synthesize existing qualitative evidence on how trial participants randomized to acupuncture and sham acupuncture groups experience non-specific effects, regardless of types of medical conditions investigated. Results: Twenty studies of high methodological quality were included. Our proposed model indicated these effects may be increased by maintaining a professional status, applying a holistic treatment approach, practicing empathy, and providing patients with an appropriate explanation of theory behind acupuncture and sham acupuncture. From patient’s perspective, the efficacy of treatment can be increased by following lifestyle modification advice provided by acupuncturists, maintaining a positive attitude toward treatment efficacy, actively engaging with acupuncturists during consultation, and making behavioral changes based on experience gained during trial. Conclusions: Results of the present study may provide basis for improving and standardizing key components of non-specific effects in acupuncture treatment and for improving the isolation of specific effects in future clinical trials involving acupuncture and sham acupuncture. (3998) Mindfullness-based Stress Reduction: Does a Crash Course Work for Medical Students? Theresa Meotti1, Daniel Rappoport1 and Mary P Guerrera, MD, FAAFP1 1Farmington, Connecticut Abstract Purpose: To determine if techniques taught by a trained and certified mindfulness-based stress reduction (MBSR) instructor over a one-week pilot course will teach students the basics of a mindfulness practice and result in a decrease in self-rated scores of perceived stress. Results: The study results are currently pending as this MBSR course and associated research will occur February to March 2018. Pre-course data will be compared to post-course data to determine effect. Conclusions: We hypothesize that the condensed MBSR training course will result in decreased perceived stress ratings among participants. Formal conclusions will be formulated after data analysis. (3999) CHIMERAS Showed Better Inter-rater Reliability and Inter-consensus Reliability Than GRADE in Grading Quality of Evidence From Cochrane Reviews: A Randomized Controlled Trial Charlene HL Wong, BSc1, Justin CY Wu, MD1, Vincent CH Chung, PhD1, Irene XY Wu, PhD1, Benjamin HK Yip, PhD1 and William KW Cheung, BSc1 1The Chinese University of Hong Kong, Sha Tin, Hong Kong, Hong Kong Abstract Purpose: To inform decision-making and guideline developing, appraising quality of evidence (QoE) is an essential process for performing a systematic review. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) is one of the tools for assessing QoE; however, concerns on its reliability and comprehensiveness were raised. To address these shortcomings, we developed the Clinical and Health Intervention Meta-analysis Evidence RAting System (CHIMERAS). This randomized controlled trial aims to assess and compare the reliability of CHIMERAS and GRADE. Results: The 100 SRs covered 17 different categories of conditions, including pharmacological (37.0%) and non-pharmacological interventions (63.0%). CHIMERAS showed moderate agreement (ICC = 0.54, 95% confidence interval [CI]: 0.44–0.64), while GRADE had fair agreement (ICC = 0.38, 95% CI: 0.28–0.49) for inter-rater reliability among individual raters. CHIMERAS showed substantial agreement (ICC = 0.78, 95% CI: 0.69–0.84), while GRADE had moderate agreement (ICC = 0.52, 95% CI: 0.36–0.65) for inter-consensus reliability across pairs of raters. With GRADE, 77.0% and 11.0% SRs were judged as having low or very low and high QoE, respectively. With CHIMERAS, 10.0% and 54.0% SRs were judged as having low or very low and high or very high QoE, respectively. Conclusions: CHIMERAS outperformed GRADE in terms of inter-rater reliability and inter-consensus reliability. CHIMERAS and GRADE also showed substantial disagreement in grading QoE, indicating the possible impact on decision-making attributable to varying rating approaches. (4000) Successful Management of Eosinophilic Esophagitis Using Traditional Chinese Medicine: A Case Report Xiu-Min Li, MD1, Song Park, BS1 and Gary Soffer, MD1 1New York, New York Abstract Purpose: • Eosinophilic Esophagitis (EoE) is a relatively recently described condition, with rapidly increasing prevalence over the past several years. • EoE is a chronic food protein induced allergic disease that involves both IgE and non-IgE mediated processes. • It typically presents with symptoms of esophageal dysmotility such as gastroesophageal reflux disease (GERD)-like symptoms, emesis, abdominal pain, dysphagia, and most severely, food impaction. • It is characterized histologically as greater than 14 eosinophils on an esophageal biopsy and diagnosis is made based on both symptomatology and pathology. • Current treatment involves food elimination and off label use of topical steroids. There is currently no alternative treatment for EoE. • Traditional Chinese Medicine (TCM) is a medical system utilizing herbs, acupuncture and acupressure. • Laboratory research provides strong evidence that some of the herbal formulas and compounds utilized in TCM reduce Th2 cytokines, IgE production and eotaxin; all have which have been implicated in EoE pathophysiology. • We describe a patient with EoE refractory to conventional treatment who was successfully treated with TCM. An 11-year-old boy with a history of EoE and subsequent failure to thrive presented to clinic after only moderate improvement with conventional therapy (elimination diet and swallowed corticosteroids). • He was diagnosed with EoE at age 10 following a long standing history of emesis, and GERD-like symptoms. Esophageal biopsy was significant for >50 eosinophils/hpfHis history was also significant for reflux, (diagnosed at 6 months), multiple food allergy (initially diagnosed at 9 months), eczema and allergic rhinitis. • He was initiated on Digestion tea and Mei Huang tea III, as well as Huo Xiang Zheng Qi Wan for weekends/reactions. He was also treated with TCM topicals, Bath Additives and Cream III. Medications were adjusted throughout his course Results: • Following initiation of TCM patient remained event free for 6 months, which was the longest duration in his lifetime. • When rare events did occur they were reduced in intensity and duration. Prior to treatment symptoms would last 48 to 72 h, now they only lasted 2 to 3 h. • Previously eliminated foods were successfully reintroduced over 3 years including, but not limited to, baked milk products (pizza), baked egg, tree nuts and legumes. • Other benefits during the TCM treatment period were resolution of eczema and a weight gain of 35 lbs. • Four years following initiation of treatment repeat endoscopy showed 0 to 7 eosinophils/hpf. Conclusions: • Eosinophilic esophagitis is one of the most rapidly emerging allergic and gastrointestinal diseases. • Treatment options are very limited and can come with significant adverse reactions. • Further research is needed, but TCM may provide a safe and effective modality for the treatment of EoE. (4001) Acupuncture and Related Interventions for Treating Carpal Tunnel Syndrome: A Systematic Review Robin ST Ho, MPH1, Vincent CH Chung, PhD1, William KW Cheung, BSc1, Victor CK Lam, BSc1, Regina WS Sit, MBBS1 and Irene XY Wu, PhD1 1The Chinese University of Hong Kong, Shatin, Hong Kong, Hong Kong Abstract Purpose: Carpal tunnel syndrome (CTS) is one of the most common upper extremity disorders. Acupuncture is a commonly used conservative treatment for CTS. However, its effectiveness for CTS is uncertain and existing systematic review (SR) is out of date. This SR was performed to provide up-to-date clinical evidence on acupuncture and related interventions for treating CTS. Results: Ten RCTs (728 participants) were included. When compared to conventional medications, manual acupuncture showed significant superior effect in improving CTS symptom than ibuprofen (mean difference [MD] = −5.80, 95% confidence interval [CI]: −7.95 to −3.65) and prednisolone (MD = −6.50, 95% CI: −10.14, −2.86). Electro-acupuncture plus splinting was more effective in reducing symptom severity than splinting alone (MD = −0.20, 95% CI: −0.36 to −0.03). Significant superior effects were shown in manual acupuncture versus ibuprofen (MD = −1.84, 95% CI: −2.66 to −1.02), and electro-acupuncture plus splinting versus splinting alone (MD = −6.22, 95% CI: −10.73 to −1.71) for improving CTS patients’ functional status. Electro-acupuncture (MD = −0.70, 95% CI: −1.34 to −0.06) and manual acupuncture with specified magnetic spectrum heat lamp (MD = −1.70, 95% CI: −3.43 to 0.03) showed add-on effect in reducing pain when compared to splinting alone. Conclusions: Electro-acupuncture could be considered as an add-on to splinting for CTS patients. Manual acupuncture, electro-acupuncture, TENS and moxibustion also be considered as an alternative to splinting for CTS patients. Future trials should use guidelines recommended interventions as control, determine the optimal follow-up duration and report the trial according to the STRICT guideline. (4002) Evaluation on Impacts of Evidence-based Health-care Education for Chinese Medicine Practitioners William KW Cheung, BSc1, Irene XY Wu, PhD1, Vincent CH Chung, PhD1, Robin ST Ho, MPH1, Justin CY Wu, MD1 and Charlene HL Wong, BSc1 1The Chinese University of Hong Kong, Shatin, Hong Kong, Hong Kong Abstract Purpose: The Hong Kong government has been adopting an approach to facilitate the development of Chinese medicine based on the principles of evidence-based healthcare (EBHC). In order to increase Chinese medicine practitioners (CMPs)’ access to EBHC knowledge and information, an intensive EBHC curriculum was tailored-made for them. A 3-day EBHC education workshop was presented in mixed interactive and didactic formats. The aim of this study was to evaluate the effectiveness of EBHC education among CMPs. Results: Among the CMPs who completed the 3-day EBHC education workshop (n = 59), there were significant improvements in attitude, perceived behavioural control, decision-making, and intention and behaviour domains based on evidence-based practice inventory questionnaire. Significant increase in scores were also observed in attitude and knowledge domains of evidence-based practice in evidence-based practice questionnaire. Conclusions: Findings of this study suggested the importance of tailored-made EBHC education in enhancing knowledge and attitudes towards evidence-based practice among CMPs in Hong Kong. To improve their perceived social influence and application of evidence-based practice, previous literature proposed that patient-oriented interventions and monitoring of CMPs might be further explored. This would help promote the advancement of local integrative Chinese-western medicine practice in an evidence-based manner in the future. (4005) A Double-blind, Randomized, 2-dose Trial of Chinese Medicine, Tumor-Shrinking Decoction, in Patients With Symptomatic Uterine Fibroids Lixing Lao, MD1, Wai L Lin, PhD1, Yan B Zhang, PhD1, Zhang J Zhang, PhD1 and Wei Meng1 1The University of Hong Kong, Hong Kong, Hong Kong Abstract Purpose: Uterine fibroids (UFs) are the most common benign tumors in females in the middle and later reproductive ages. On the basis of empirical evidence and clinical practice, a formula called Tumor-shrinking Decoction (TSD) was developed for the treatment of UFs. The present study was designed to assess the clinical efficacy of TSD in the therapy for UFs through an extensively controlled trial. Results: Of the 78 randomized subjects, 73 patients completed the study. The end point outcomes showed significant improvement in both groups in UF symptom severity, pelvic pain, TCM syndrome, fibroid size and uterus condition under MRI; but no significant between-group differences were found in all measured clinical outcomes at any time point, except for TCM syndrome. The changes (mean ± SD) in UF symptom severity measured by UFS-QOL in low-dose group and high-dose group after 20 weeks were 14.30 ± 4.28 and 13.72 ± 4.26 respectively (P > .05). Low-dose TSD rather than high-dose TSD significantly improved patient’s quality of life (TSD-L baseline vs end point: 46.07 ± 17.08, 52.37 ± 16.95, P < .05). No serious adverse events were reported in this study. On the safety front, all the tested samples fulfilled the Hong Kong Chinese Materia Medical Standards. Conclusions: The herb formula TSD was safe and stable in treating UF. Both low-dose and high-dose TSD significantly ameliorated UF-related symptoms and fibroid size, but not the quality of life. The dose–response relationship seems to be absent in TSD for treating UF. Further studies with larger sample size are warranted. (4008) Comparative Effectiveness of Individual Versus Group Acupuncture Therapy for Chronic Pain and Function in an Underserved Population Belinda J Anderson, PhD1, Arya Nielsen, PhD2, M Diane McKee, MD, MS2, Elizabeth Chuang, MD, MPH2, Florangel De León, BA2, Mimi Kim, ScD2, Qi Gao, PhD2, Eric N Gil, BA2, Claudia Lechuga, MS2 and Benjamin Kligler, MD, MPH2 1Pacific College of Oriental Medicine, New York, New York 2Bronx, New York Abstract Purpose: Chronic pain is prevalent in the United States; minority populations experience greater prevalence of chronic pain and worse outcomes. While acupuncture therapy has been shown to be effective for chronic pain, minority, ethnically diverse and lower socioeconomic populations are limited in access. Group acupuncture is proposed as a lower cost option to facilitate access in safety net settings but research that establishes effectiveness compared to individual session acupuncture therapy is lacking. Our trial aimed to assess non-inferiority of group acupuncture therapy to individual acupuncture therapy for chronic pain, function and depression in a safety net setting. Results: Study participants were mostly Medicaid insured (75%). More than half (60%) reported poor or fair health; 51% were on SSI, and 37% were unable to work due to disability. Of the 706 participants, 360 were randomized to individual treatment and 346 to group. Retention rates were 87% at 6 weeks, 85% at 12 weeks and 84% at 24 weeks. Randomization to group setting did not affect initiation or retention in treatment. The mean number of treatments was 8.1 with no difference between arms. In the intent-to-treat analysis, 34.8% of individual and 30.5% of group participants achieved the primary end point of 30% or more reduction on pain, corresponding to between group difference of d = 4.3% (95% CI: −3.3%, 11.9%). While clinical improvement was shown in both arms, non-inferiority of group acupuncture could not be demonstrated since the upper boundary of the 95% CI exceeded the non-inferiority margin of 10%. For BPI pain interference, 30% or greater improvement was reported by 37.5% of participants in individual and 30.3% in group care, corresponding to a difference of d = 7.2% (95% CI: −0,6%, 15.1%). In per-protocol analysis, limited to those participants who received an adequate course of treatment (8 or more treatments), 39.2% of individual versus 36.3% of group participants reported 30% or better improvement in pain severity (d = 2.8%; 95% CI: −6.5%, 12.2%) and 39.7% of individual and 34.4% of group participants reported 30% or greater improvement in pain interference (d = 5.3%; 95% CI: −4.2%, 14.9%). Few minor adverse events and no serious adverse events were reported. Secondary outcome data and 24-week data are pending. Conclusions: While non-inferiority of group to individual acupuncture therapy was not shown at 12 weeks, levels of clinical improvement were still impressive, with more than 30% of participants achieving the primary end point. Randomization to a group setting did not impact initiation or retention in treatment. Group acupuncture is feasible and may be considered an option for patients with chronic pain in a safety net setting. (4009) Yoga, Physical Therapy, and Education for Sleep Quality in Adults With Chronic Low Back Pain: A Secondary Analysis of a Randomized Controlled Trial Robert B Saper, MD, MPH1, Eric Roseen, DC1, Alexandra Femia, MS1, Jae Cho, BA1, Suzanne Bertisch, MD, MPH1 and Susan Redline, MD, MPH1 1Boston, Massachusetts Abstract Purpose: Poor sleep quality is common among adults with chronic low back pain (cLBP). While yoga and physical therapy (PT) are effective cLBP treatments, their impact on sleep quality in adults with cLBP is unknown. Results: Participants (mean age = 46.0 [SD = 10.7]; mean PSQI score = 10.2 [SD = 3.9]) were mostly female (64%), black (57%), and had poor sleep quality (93%). Sleep quality improved at 12 and 52 weeks among yoga (PSQI mean difference [MD] = −1.2 [95% CI: −1.9, −0.6] and −2.4 [95% CI: −3.2, −1.5], respectively), PT (MD = −1.1 [95% CI: −1.8, −0.3] and MD = −1.7 [95% CI: −2.7, −0.7], respectively), and education (MD = −0.5, [95% CI: −1.4, 0.5] and MD = −1.0 [95%CI: −2.1, 0.1], respectively) participants. Small non-significant (P > .05) between-group differences favored Yoga and PT to education at 12 (MD = −0.7 and −0.5, respectively) and 52 (MD = −1.1 and −0.5, respectively) weeks. More yoga (35%) and PT (35%) than education (25%) participants were responders (P = .37). Conclusions: In a sample of adults with cLBP, the vast majority had poor sleep quality at baseline. Small within-group improvements in Yoga and PT groups were similar in magnitude; the education improvement was less in magnitude. (4014) Psychosocial Interventions as Adjuncts to Orthopedic Surgery: A Systematic Review and Meta-analysis Csenge Szeverenyi, MD1, Zoltan Kekecs, PhD2, Gary Elkins, PhD3, Zoltan Csernatony, MD, PhD, DSc1, Katalin Varga, PhD, DSc4 and Alisa Johnson, MA3 1University of Debrecen, Debrecen, Hungary 2Lund University, Lund, Sweden 3Baylor University, Waco, Texas 4Eotvos Lorand University, Budapest, Hungary Abstract Purpose: The present study aims to assess the effectiveness of psychosocial techniques to decrease postoperative pain and improve perioperative clinical care in orthopedic surgery. A systematic review and meta-analysis was performed to evaluate the effects of psychosocial methods (eg, patient education, relaxation techniques, therapeutic suggestions, cognitive or behavioral interventions, and combinations of these) on pain, anxiety and functional recovery in short and long-term follow-up among adults undergoing orthopedic surgeries. The study was designed to specifically answer the following questions: Can the applied psychosocial techniques reduce (1) postoperative pain, (2) analgesic use, (3) preoperative anxiety, (4) postoperative anxiety, and enhance (5) quality of life and (6) recovery in adults undergoing orthopedic surgery; and (7) what are the moderating factors of effectiveness? This information is needed to aid healthcare providers and insurance companies in identifying best practices in surgical procedures. Results: The meta-analysis of 62 RCTs demonstrated that psychosocial interventions significantly reduced postoperative pain (0.31 [0.14, 0.48]), and pre- and postoperative anxiety (g = 0.26 [95% CI = 0.11, 0.42] and 0.4 [0.21, 0.59], respectively). Furthermore, psychosocial interventions improved recovery (0.38 [0.22, 0.54]). However, no significant effects were found for postoperative analgesic use (0.16 [−0.01, 0.32]) and quality of life (0.14 [−0.05, 0.33]). Electiveness of surgery was a statistically significant moderator of effectiveness (eg, pain, analgesic use, anxiety). Type of surgery (major vs minor) and timing of interventions did not moderate effects. Conclusions: Compared with a previous orthopedic surgery meta-analysis,98 this meta-analysis expands the current knowledge base by including preoperative measures, long-term recovery outcomes, and several types of psychological interventions. Patient education and relaxation techniques produced the most consistent positive effects, showing benefits on pain, anxiety, and recovery. Cognitive or behavioral techniques improved recovery. Furthermore, larger effects were found for studies that included acute surgeries compared to elective surgeries. The current analysis revealed encouraging findings regarding the effects of psychosocial interventions on postoperative pain and related outcomes such as anxiety and recovery, warranting future clinical investigations to improve researcher’s confidence in the size of the effects. More well powered high-quality studies are needed. The effects of psychosocial interventions are most consistent on decreasing preoperative anxiety. Evidence supports the use of patient education to decrease postoperative pain, pre- and postoperative anxiety, relaxation techniques to ameliorate postsurgical pain and anxiety, and improve recovery, and cognitive or behavioral interventions to improve recovery. In this meta-analysis of RCTs in orthopedic surgeries, significant benefits in postoperative pain, perioperative anxiety and recovery were found, suggesting that psychosocial interventions, especially patient education and relaxation techniques, are useful in improving the clinical care. (4015) Effect of a 5-Day Ketogenic Diet on Chemotherapy Side Effects: A Case Series Report Carla Kuon, MD1, Carla Kuon, MD1 and Anand Dhruva, MD1 1San Francisco, California Abstract Purpose: Fasting may be effective in reducing side effects of chemotherapy. Tumor cells typically demonstrate a high glycolytic rate, termed the “Warburg effect.” As a result, glucose and glutamine become prime fuels for the dysregulated growth of tumors. Fasting, as well as fast-mimicking diets such as the ketogenic diet, have anti-tumor and anti-inflammatory properties, purportedly by turning off the glycolytic pathway and switching energy production to fatty acid metabolism and ketones. In addition, high-fat diets in murine mouse models have been shown to reduce leukocyte recruitment and activation by lowering inflammatory cytokines. Results: Case 1: 53-year-old male with BRAF mutant, colon cancer with metastasis to liver, was receiving vemurafenib, cetuximab, and irinotecan every 4 weeks. He experienced side effects of diarrhea, skin rash, fatigue, and a 10-pound weight loss. He was hospitalized for dehydration after his first infusion and required 3 days of anti-diarrheal medication after each infusion, consistent with CTCAE category 3 side effects. After placement on a 5-day ketogenic diet, he suffered minimal diarrhea, trace fatigue, and enjoyed increased appetite. CTCAE level was reduced from category 3 to category 1. Case 2: 68-year-old female with stage 2C clear cell ovarian cancer, receiving paclitaxel every 28 days. She voluntarily started a ketogenic diet to reduce side effects of therapy and to achieve weight loss. Prior to starting this diet, she suffered severe fatigue, anorexia, nausea, neuropathy, insomnia, and joint pain after chemotherapy. After starting the ketogenic diet, she experienced minimal side effects, lowering her CTCAE category from 2 to 1. Conclusions: Both patients achieved a reduction of chemotherapy-related side effects based on CTCAE criteria upon switching to a ketogenic diet, timed around chemotherapy. Both diets were well-tolerated. We propose that a 5-day ketogenic diet may be a viable way to reduce side effects of chemotherapy. Further studies are warranted. (4016) Effects of a Modified Ramadan Fasting on Physical and Mental Health in Healthy Adult Muslims – A Randomized Controlled Trial Gustav Dobos, MD, PhD1, Holger Cramer, PhD1, Romy Lauche, PhD2, Petra Klose, PhD1, Chalil Saddat, MD1, Iman Fathi, MD1, Thomas Rampp, MD, PhD1, Jallal Al-Abtah, BNurs3 and Arndt Büssing, MD, PhD4 1University of Duisburg-Essen, Essen, Germany 2University of Technology Sydney, Sydney, Australia 3Kliniken Essen-Mitte, Essen, Germany 4University of Witten/Herdecke, Herdecke, Germany Abstract Purpose: Fasting during the month of Ramadan is considered one of the 5 pillars of the Islamic religion, and Muslims must abstain from eating and drinking between dusk and dawn. Research has found that fasting during Ramadan affects the health of Muslims, but study results were often contradictory about the direction of those effects. Therefore, this study aimed to determine whether a modified fasting regimen is beneficial for physical and mental health among adult Muslims undergoing Ramadan fasting. Results: A total of 112 participants (63 females and 49 males; 27.8 ± 9.4yrs) were randomised, and no drop-outs occurred. After Ramadan, the experimental group reported significant higher well-being (WHO-5, MD: 5.93; 95% CI: 0.02 to 11.84), with 57.8% and 42.2% of participants in experimental and control groups being responders, respectively. Analyses revealed further group differences regarding satisfaction with life, and mindfulness, weight, body mass index, hip circumference, and blood pressure directly after the intervention; however no group differences were found for serum markers. About 60% of participants reported adverse events, including headaches, dizziness, and gastrointestinal symptoms. Creatinine was elevated in 2 participants. Two serious adverse events occurred, but they were not intervention-related. Conclusions: A modified Ramadan fasting regimen appears to improve mental and physical health of Muslims; though observed effects were rather small and short-term only. Since the major limitation of this trial is the overrepresentation of young and healthy Muslims, further research is warranted to examine the effects of similar interventions in a sample of adults with diagnosed CVD risk factors. (4017) A Case Report of a Cerebral Infarction Patient With Shoulder Pain Using Korean Medical Treatment Hee J Seo1, Jung N Kwon1 and So H Shim1 1Korean Medicine Hospital of Pusan National University, Yangsan, Republic of Korea Abstract Purpose: Shoulder joint pain in stroke patients with hemiplegia is one of the most common complications within 2 weeks after stroke and is a complaint in about 70% of patients. In addition, shoulder joint pain causes not only pain in stroke patients but also disabilities in rehabilitation treatment, resulting in social and economic loss, and also negative effects on the quality of life of patients and caregivers. The purpose of this clinical study is to evaluate the effect of Korean Medical Treatment on a 79-year-old Korean female with shoulder pain after stroke. Results: After 24 days, total score of NRS was decreased from 7 to 2.1. Average sleep time was increased and waking up due to shoulder pain was decreased during the night. Conclusions: This study suggests that Korean medical treatment, especially Moxibustion could be effective to reduce shoulder pain in stroke patients with hemiplegia and alleviate sleep disturbance. Further studies are needed. (4018) High-velocity, Low-amplitude Spinal Manipulation Training of Prescribed Forces and Thrust Duration: A Pilot Study Zacariah K Shannon, DC, MS1, Maruti R Gudavalli, PhD2, Ron J Boesch, DC1 and Robert D Vining, DC1 1Palmer College of Chiropractic, Davenport, Iowa 2Illinois Institute of Technology, Chicago, Illinois Abstract Purpose: High-velocity, low-amplitude spinal manipulation (HVLA-SM) is a manual therapy that induces different physiological effects depending on peak force and thrust duration. Inter-clinician variability in thrust force delivery suggests training clinicians to target specific force levels may be necessary to standardize treatments, which has implications for research and practice. This pilot study developed and assessed an HVLA-SM training program. Results: No difference in peak force mean absolute error (AE) from target was noted between the 8 student and 8 doctor of chiropractic participants. Adjusted mean AE (SD), (adjusted 95% CI) were: baseline, 107N (127), (40 to 175) at 350N and 63N (148), (−16 to 142) at 550N, immediately post-training, 0.2N (41), (−22 to 22) at 350N and −6N (58), (−37 to 25) at 550N, and 8 weeks post-training, 32N (53), (4 to 60) at 350N and 9N (87), (−38 to 55) at 550N. Median thrust duration was 117 ms at baseline and 134 ms immediately post-training. Conclusions: This HVLA-SM training resulted in improved ability to deliver prescribed forces, however accuracy lessened after 1 week. Further study to understand how to maintain skill over the long-term is warranted. (4020) Mindfulness Training Disrupts Classical Conditioning Eric Garland, PhD1 and Adam W Hanley, PhD1 1Center on Mindfulness and Integrative Health Intervention Development, Salt Lake City, Utah Abstract Purpose: Mindfulness meditation is purported to de-automatize conditioned behavior. Conditioned behavior is implicated in a host of clinical concerns, including depression, addiction, and suicidality. However, the effects of mindfulness on classically conditioned behavior has not been assessed in a controlled experiment. This study is the first to demonstrate that mindfulness meditation training can attenuate classically conditioned behavior. Results: Repeated-measures analysis of variance revealed a significant Condition × Time interaction for state mindfulness (F5,35 = 3.52, P = .011, η 2 = .34), indicating that mindfulness training increased state mindfulness (Figure 1). A one-way analysis of covariance (ANCOVA) revealed a significant mean difference in first conditioned response (F1,46 = 6.12, P = .017, η 2 = .12), indicating that mindfulness training delayed the onset of conditioned responding (Figure 2). A repeated measures ANCOVA revealed a significant main effect of condition on conditioned response frequency, (F1,46 = 16.95, P < .001, η 2 = .27), indicating that mindfulness training attenuated conditioned responding (Figure 3). Finally, path analysis revealed experimental condition had a significant indirect effect on conditioned response frequency via change in state mindfulness (Figure 4). Conclusions: Findings from this study indicate that mindfulness training inhibits the acquisition of conditioned behaviors and the frequency with which conditioned behaviors are expressed. Thus mindfulness training may serve to inoculate against the development of maladaptive habits, allowing individuals to behave non-reactively and with greater intentionality when responding to present moment circumstances. (4021) An Exploratory Study of Core Values and Depression in Adults With Type 2 Diabetes Suzanne Danhauer1, Shannon L Mihalko, PhD1, Beverly Levine, PhD2, Jaimie C Hunter, PhD2, Julienne Kirk, PharmD2, Heather L Black, PhD3, Sally A Shumaker, PhD2 and Deanna Befus, PhD2 1Wake Forest University, Winston Salem, North Carolina 2Wake Forest School of Medicine, Winston Salem, North Carolina 3Merck Sharp & Dohme Corp., North Wales, Pennsylvania Abstract Purpose: Patients managing Type 2 Diabetes face many adherence challenges. Depressive symptoms are common among adults with diabetes and can substantially impact glycemic control and self-management. Values associated with maintaining good health may conflict with other core values (needs), making optimal adherence difficult. The primary aims of this analysis were to identify values relevant to managing diabetes and examine the impact of depression on these values. Results: Of the original 108 in our sample, 106 had complete data on the PHQ-8. Of these, 58% were female; mean age was 56.7 (SD = 10.4, range 29–79) years. By design, there were nearly equal numbers of White (50.9%, n = 54) and African American (49.1%, n = 52) participants. Mean PHQ-8 score was 5.5 (SD = 5.1, range 0–22), and 18% (n = 19) reported a significant level of depressive symptoms (PHQ-8 ≥ 10). Across participants, the “top 10” values reported were: love/belonging (14.6%, n = 85), self-care (13.8%, n = 80), control (10.3%, n = 60), life/survival (10.1%, n = 59), accomplishment (9.1%, n = 53), self-esteem (7.4%, n = 43), independence (6%, n = 35), peace (4.5%, n = 26), security (3.8%, n = 22), and faith/spirituality (2.8%, n = 16). There were no differences in the rank order of core values by depression status (P = .5). Conclusions: We assessed and ranked the core values of people with diabetes and examined these values across depression status. We found no evidence of an association between depression status and ranking of values. Future research should consider whether other aspects of living with diabetes vary according to depression status. (4026) Manual Therapy Based on the Myofascial Meridians Theory for Scapulohumeral Periarthritis: A Clinical Observation Kang Liu, MD, MS1, Chun Li, MD, MS2 and Zhonglong Li, MD, MS3 1Beijing Hospital, National Center of Gerontology, Beijing, China 2China Academy of Chinese Medical Sciences, Beijing, China 3UCLA, Beijing, China Abstract Purpose: Scapulohumeral periarthritis is chronic injury inflammation of the muscle, tendons, bursa and joint capsule. Its morbidity accounts for 8% of orthopedic diseases. Myofascial meridians theory has been widely used in sports, rehabilitation, medicine and other fields. The purpose of our article is to observe the efficacy of using new manual therapy based on the myofascial meridians theory on scapulohumeral periarthritis. Results: Pain relief and improvement of shoulder function therapeutic effects had been achieved in the treatment of scapulohumeral periarthritis in 2 groups (P < .05), and there is no obvious difference (P > .05) between the treatment group and control group. Conclusions: Manual therapy based on the myofascial meridians theory has obvious therapeutic effect on scapulohumeral periarthritis, it provides a method of feasible, economical and easy to operate for the treatment of scapulohumeral periarthritis. (4028) BASIC-health: A 16-h Course, Produces Measurable Salutogenesis in Pain Patients, by Linking Exteroception With Interoception Through Physical Movement Daniela H Jurisic, MD1 and Judith B Kosasih, MD2 1Active Integrative Medicine Associates, Pavia, Italy 2Medical College of Wisconsin, Milwaukee, Wisconsin Abstract Purpose: To explain the development, testing and clinical results in 75 patients, of BASIC-health (Body as a Source of Identification and Coherence for Health): a medically guided somatic practice invented for salutogenesis activation. Results: Clinical trial: 75 patients (5 min); 80 patients enrolled within 2 years, ages 45–78, 58 women and 22 men. Diagnoses: chronic fatigue syndrome, post-laminectomy pain, post-chemotherapy pain and asthenia, and post-acute disabling pain. All patients: examined by the same physician who invented and taught the course; 42 improved by 4 points; 27 improved >12 points; 6 improved 0–1 point; 0 worsened. Enjoyment level: reported as uniformly positive; 6-month follow-up: 58 of 75 participants were continuing with some form of specific salutogenic movement. No patients reported increased pain or disability. Conclusions: “BASIC” can be a clinically useful tool toward activating salutogenesis by directly teaching and practicing increased somatic perception. It is integrative medicine both in its scientific basis and its emphasis on the therapeutically relating to the whole person. It is direct, time-effective and has proven to be efficacious in 75 patients, with maintained efficacy on 6-month follow-up. (4030) How to Explore the Effectiveness of Traditional Chinese Herbal Medicine in a Pragmatic Randomized Controlled Trial? Experiences From Treating Diabetic Kidney Disease Xinmiao Wang, MM1, Bing Pang, MD1, Linhua Zhao, MD1, Zhao Xuemin, MM1 and Ying Zhang, PhD2 1Guang’anmen Hospital, China Academy of Chinese Medicine Sciences, Beijing, China 2Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: In clinical practice, double-dummy and actively controlled design is necessary for examining the effectiveness and safety of Shenzhuo Formula (SZF) in the treatment of DKD patients with macroalbuminuria. However, we will still face many challenges to choose candidate western medicine (WM) as a control group and administrate corresponding simulation agents in routine treatments. The drug preparation of either simulation SZF or WM agents in both groups is quite difficult, which may lead to the deficiency of the implementation of blinding. To maintain patients’ compliance and relative ethical issues also need to be considered carefully. In our ongoing trial, we have made several efforts to make it practicable and ethical. Results: Currently, more than 50 patients have been recruited, and the overall dropout rate is less than 20% by monitoring. Adverse events (AEs), such as signs and symptoms and other ailments, are documented at every visit. Most of the adverse reactions are mild until now, including urticaria, edema, diarrhea, and so forth. Conclusions: In order to provide initial evidence regarding the effectiveness and safety of SZF in the treatment of DKD, in addition to the real treatment effect, good clinical management strategies also play an important role in the double-dummy PRCT. (4031) Stand-Alone Ayurvedic Treatment in Acute Ischaemic Stroke: A Pilot Study Archana Purushotham, MD, PhD1, Aarthi J Harini, BAMS2, Avineet Luthra, BPT, MSc2, Shrey Madeka, MSc2, Prasan Shankar, BAMS, MD(Ayu.)3, Pitchaiah Mandava, MD, PhD4, Ravishankar Pervaje, BAMS, MD(Ayu.)5 and Sanjith Aaron, MD, DM6 1Stony Brook School of Medicine, The State University of New York, Stony Brook, New York 2Institute for Stem Cell Biology and Regenerative Medicine, Bangalore, Karnataka, India 3Institute for Ayurvedic and Integrative Medicine, Bangalore, Karnataka, India 4Houston, Texas 5Sushruta Ayurveda Hospital, Puttur, Andhra Pradesh, India 6Christian Medical College and Hospital, Vellore, Tamil Nadu, India Abstract Purpose: The Allopathic arsenal for treating ischaemic stroke is rather limited, and the only treatments shown to improve outcomes – thrombolysis and angio-intervention – are not accessible to the majority of stroke patients across the globe. Stroke patients in the Indian sub-continent commonly use Ayurvedic therapies, but there is no evidence regarding the efficacy or safety of these therapies, the latter being of particular concern in acute ischaemic stroke (AIS). Ayurvedic therapy could prove especially valuable if found efficacious, as it can be used well beyond the ‘golden hour’ for thrombolysis and thrombectomy. We carried out a pilot observational study of the safety profile of stand-alone Ayurvedic treatment in AIS. Results: We enrolled 13 patients into the Ayurvedic and 20 patients into the Allopathic arm. One patient in the Ayurvedic arm was lost to follow-up but mortality data could be obtained. Significant baseline imbalances in pre-stroke disability, initial National Institutes of Health Stroke Scale (NIHSS) and time from stroke onset to initiation of treatment were improved after the matching process which yielded 11 matched pairs of subjects. Pooled analysis of outcomes did not show statistically significant differences in mortality (15.38% vs 15%, P = 1.00), non-fatal adverse event rates (15.38% vs. 30%, P = .4) or improvement in NIHSS: 3 (IQR 2-6) versus 4 (IQR 0–6), P = 1.00. The paired analysis of the 11 matched pairs continued to suggest that the safety profiles of classical Ayurveda and conservative Allopathy in AIS are similar. Conclusions: Stand-alone classical Ayurvedic treatment of AIS is safe. This is the first ever report of stand-alone Ayurvedic therapy in AIS. Our results support the conduct of a larger randomized controlled trial to study the efficacy of Ayurvedic treatment of AIS. (4032) Measuring What Matters in Primary Care Rebecca Etz, PhD1 and Kurt C Stange, MD, PhD2 1Virginia Commonwealth University, Richmond, Virginia 2Case Western Reserve University, Cleveland, Ohio Abstract Purpose: Health-care systems based on primary care have healthier populations, greater equity, and lower cost. However, current quality measures do not reflect most of the integrative mechanisms hypothesized to provide this value. Incorrectly focused measurement and incentives risk burning out the workforce and diminishing the value of primary care for people and populations. This article conveys findings from efforts to understand what matters in primary care and how it can be measured. Results: The apparent simplicity of primary care masks the complexity of integrating, personalizing, and prioritizing care for people and communities. This interrelated complexity does not fit well into usual reductionist classification systems that assume that the whole is merely the sum of its parts. We identified two complementary ways of understanding and assessing primary care: First, building on principles from complexity science, we uncovered three simple rules that, when actualized together by patients and practices and supported by systems, describe the processes from which the outcomes of primary care emerge as follows: recognize and prioritize problems/opportunities (for person and population at all stages of life); make sense of the problem/opportunity through a life course perspective and being known (as an individual and as a member of family and community); generate some kind of relief, comfort, connection, or health. The enactment of these apparently simple rules, over time, in ongoing primary care relationships, leads to the emergence of better health and equity at sustainable cost. Second, a parsimonious set of individual items, used as a set, rather than assessed individually, can focus attention and support on the mechanisms by which primary care provides value are as follows: accessibility—includes the first contact with the health-care system; comprehensiveness—focusing on the whole person; integration—bringing together the biological and the biographical across acute and chronic illness, prevention, mental health, and family; coordination—managing care across different clinicians and settings; relationship—being known, continuity of care, longitudinality (being together over time), sustained partnership, being present for key events, and trust; advocacy (looking out for the person in fragmented health-care or social systems); family context, knowledge, and engagement that informs and supports care; community context, knowledge, and engagement, including social and environmental determinants; goal-oriented care; disease and illness management; patient enablement. As a starting point for future work, we provide a table that outlines these measures and suggests related contextual and outcome measures in current use, and appendices that depict specific patient report measurement items. Conclusions: These two ways of knowing and assessing primary care—simple rules from which complexity emerges, and a parsimonious set of items representing key mechanisms—can be used as a starting point to reduce measurement burden and to focus attention on improving the means by which primary care provides value. (4034) Exploring Integrative Modalities With Interprofessional Education Lilian White, BS1, Lucas Harrison, BS1, Kim Gilliam, EdD/PC1 and Patrick Jonas, MD1 1Boonshoft School of Medicine, Wright State University, Dayton, Ohio Abstract Purpose: The purpose of this investigation is to assess the attitudes of health professions students toward the value of selected modalities in integrative medicine. A survey will be conducted for an educational event including a keynote presentation by an integrative practitioner and a period of workshops in integrative care modalities. Students will choose two 1-h workshops to attend. A survey will be conducted following the event. The findings of this survey will inform the founding of an interprofessional interest group in integrative medicine at the Boonshoft School of Medicine, Wright State University. The specific aims of this study are to assess the attitudes of health professions students toward massage, acupuncture, osteopathic manipulative therapy, nutrition, meditation/mindfulness, and aromatherapy. Complementary care has become increasingly utilized by U.S. patients. A study by Eisenberg et al. cited a rise in the use of complementary therapies by patients in the United States from 33.3% in 1990 to 42.1% in 1997. A more recent study in 2007 demonstrated that 4 in 10 adults use complementary therapies; however, only one third of patients surveyed reported talking about their use of complementary therapies with their physician. The discrepancy between use and disclosure begs for more physician education and comfort with complementary therapies to facilitate open communication between patient and physician and to minimize the potential for adverse effects. Currently 54 medical schools and 8 medical systems nationwide have joined in the effort to advance education in integrative care through the Academic Consortium for Integrative Medicine and Health. In the Dayton area, there are multiple schools of health professions students that may benefit from more education in complementary and integrative care. Students from schools invited to participate in the event include University of Dayton (dietetics, physical therapy, and physician’s assistant), Sinclair Community College (dietetics and nursing), Clark State Community College (nursing), Cedarville University School of Pharmacy, Kettering College of Medical Arts (nursing, occupational therapy, and physician’s assistant), Ohio University—Grandview location (D.O.), Dayton School of Medical Massage, and Wright State University Schools of Medicine and Professional Psychology. We hypothesize that students will be more willing to recommend attended workshop modalities. Results from the survey will guide the agenda for the coming year of interest group activities in integrative medicine and serve as a baseline for future surveys. Results: A total of 54 students from the invited institutions attended. Students attending the event were primarily female, between the ages of 18 and 27, Caucasian, and affiliated with the Wright State University Boonshoft School of Medicine. The workshop with the highest attendance focused on meditation and mindfulness. Of the workshops attended, nutrition was the topic students were most likely to recommend. Using the CHBQ questionnaire, the mode for statements with “7” or “absolutely agree" included: “The physician’s role is primarily to promote the health and healing of the physical body; a strong relationship between patient and physician is an extremely valuable therapeutic intervention that leads to improved outcomes; mindfulness practices are a useful tool for patients.” The mode for statements with “1” or “absolutely disagree” included: “The spiritual beliefs and practices of physicians play no important role in healing; the spiritual beliefs and practices of patients play no important role in healing; meditation can benefit patient’s health temporarily, but does not have long-term benefits. Conclusions: Overall, each workshop attended showed an increase in students’ willingness to recommend the integrative modality to future patients. Attitudes toward the spiritual beliefs and practices of patients and physicians alike were not viewed as integral to the healing process as addressing the physical body and meditation/mindfulness practices. Recommendations by attendees for next year include hosting the event on a Saturday and allowing participants to attend more than 2 workshops. Following the event, a total of 33/54 participants expressed written interest in creating an interprofessional student group to host workshops throughout the year on integrative modalities. The student group—also named Project Wellness—is now an established organization at the Boonshoft School of Medicine, Wright State University. A grant from the leadership and education program for students program and additional funding from the student affairs department at the Boonshoft School of Medicine supported the project. (4035) What IMPACT Contributes to Integrative Medicine Matthew Carvey, BSc, EMT-P, FP-C1 and Robert Hage, MD, PhD1 1St. George’s University, St. George’s, Grenada Abstract Purpose: Integrative medicine’s intent is to restore and maintain health and wellness during a person’s lifetime through aspects which influence the body, mind, spirit, and community. Future integrative medicine practitioners should embrace its principles and commit themselves to self-exploration and self-development. Basic science medical students at St. George’s University, Grenada who registered for the integrative medicine selective are offered sessions on yoga, Reiki, acupuncture, hypnosis, naturopathic medicine, and many other topics. Results: Results will be tabulated based on the data gathered, utilizing the methods discussed, in future integrative medicine courses at St. George’s University. Conclusions: IMPACT is a fun way for students to engage in this selective and will have an influence on future health-care providers. Knowledge of the different modalities adds to aptitude, and the components of IMPACT directly govern the attitudes of health-care workers. Because IMPACT directly influences the health-care workers attitude and aptitude in integrative medicine, knowledge of the modalities gained through this presentation will openly influence how the practitioner approaches patient care in the future. (4036) Systematic Acupuncture for Cervical Pathology Daun Jeong, BOM1 1Pureunsan Korean Medical Clinic, South Korea, Gwangju City, Republic of Korea Abstract Purpose: Acupuncture is widely used for pain relief. Although acupuncture has a long history, clinical practice manual for diagnosis, physical exam, and treatment has not been established yet. To project evidence-based manual, neurophysiological, anatomical, and biomechanical scheme was adopted. Systematic acupuncture manual will be helpful for practitioners of primary care. Results: http://prezi.com/bejlqofmfodj/?utm_campaign=share&utm_medium=copy Conclusions: Acupuncture is an effective treatment option, as a substitute for analgesics or an adjunct therapy. Well-established diagnosis and treatment manual which is based on neurophysiology, anatomy, pathology, and biomechanics can promote active interactions among other health-care providers. Eventually, acupuncture can shed a light in integrative patient care. (4037) A Research on the Development of the Abdomen diagnosis Devices Based on Traditional Korean Medicine Keun Ho Kim, PhD1 and Jun-Su Jang, PhD1 1Korea Institute of Oriental Medicine, Daejeon, Republic of Korea Abstract Purpose: Abdomen diagnosis of traditional Korean medicine is based on the synthetic analysis of the tension, the skin thickness, the structural ratio, the color, and the relative temperature distribution of the abdomen for understanding the pathology of internal organs and establishes criteria for pattern identifications for correct treatment. The purpose of this study is to develop diagnostic devices, which imitate the abdomen diagnosis and an algorithm to classify functional dyspepsia (FD) by using the devices. Results: In order to evaluate the measurement reliability of the pain cognitive measuring device, the measurement repeatability of the pressure and the depth according to the difference in the lower repulsive force of the sponge structure over time was evaluated. The upper structure of the sponge structure is a common sponge having a thickness of 1T. In the lower structure, conditions 1, 2, and 3 are a sponge of 3T, a high elastic sponge of 3T, and 3T thick plastic, respectively, where the forces of 5kgf were applied to 3 structures for 10 s in accordance with the pressure–time graph guide. It was confirmed that the depth value changed when the same pressure guide was applied according to the difference of the repulsive force of the substructure. The temperatures of the four portions from IRT before and after the correction by the tactile sensor were measured. In both subjects 1 and 2, the temperature deviation after the correction was smaller than that before the correction. The correlation coefficient was also found to be higher after calibration than before calibration. For evaluating the repeatability of the 3-dimensional geometric information measurement device, experiments were performed by using a manikin with no change in geometric information. The scan data were acquired so that the robustness of the device could be confirmed by slightly changing the position and color of the manikin every time. As a result of the repeatability evaluation of the geometric features and color information of CIE L* a* b*, the standard deviations were 0.3–0.8 mm and 0.5–1.5, respectively. Conclusions: We suggested the development of measurement devices for abdomen diagnosis and presented their reliability. Since FD is also a chronic disease, it needs to be developed as a system capable of collecting and managing personal medical data of patients with chronic medical illnesses connected to the Internet. If the diagnostic algorithm is developed through clinical research, the marketability of traditional medical devices is expected to increase greatly. Funding: The research was supported by the Korea Evaluation Institute of Industrial Technology (Project Number: 10060251). (4039) Analysis of Facial Features Among Native Japanese and Native Korean Populations According to Sasang Types Lin Ang, Bachelor of Medicine (Chinese Medicine)1, Lee Jeongyun, MD, ( Korean Medicine), PhD1, Kim Jong Yeol, MD, and ( Korean Medicine), PhD1 1Korea Institute of Oriental Medicine, Daejeon, Republic of Korea Abstract Purpose: Facial diagnosis is a common practice and essential diagnostic method used in the Sasang Constitution Medicine (SCM). SCM is a kind of personalized medicine in Traditional Korean Medicine which categorizes people into four types, namely, Tae-Yang type, Tae-Eum type (TE), So-Yang (SY) type, and So-Eum (SE) type. This study is conducted to compare and analyze the differences in facial feature across Sasang types among Native Japanese and Native Koreans. Results: Significant differences can be seen in the facial feature variables related to lower face area and eye shape. TE type had wider lower face area and narrower eyes as compared to other constitutions in both gender. Besides that, SY type for male and SE type for female had rounder eyes. In general, the average lower face area for Native Koreans was larger compared to Native Japanese, whereas Native Japanese have rounder eyes than Native Koreans in male and vice versa in female. Conclusions: This study presented distinctive feature in lower face area and eye shape among the Sasang types in both Native Japanese and Native Koreans. This suggested that facial feature variables can be used as an objective tool in the distinguishing the Sasang types in Native Japanese. Further studies with a larger sample size will be needed to generalize these results. (4040) Use of Traditional Medicine for Maternal Well-being Among African Migrant Women in Australia: Implications for Improving Culturally Responsive Integrated Health Care Tinashe Dune, PhD1, Zewdneh Shewamene1 and Caroline Smith, PhD1 1Western Sydney University, Sydney, Australia Abstract Purpose: Existing evidence regarding the traditional health practices and beliefs of African minorities in Western countries is limited. The purpose of this study was to explore the use of traditional medicine for maternal well-being among African migrant women in Australia. Results: A total of 319 participants completed the survey. Overall, 232 (72.7%) women reported using some form of traditional medicine for maternal well-being in Australia. The most frequently used therapies and services were herbal medicine (163, 61.7%), prayer for health (146, 55.3%), vitamins (88, 33.3%), massage (87, 33%), faith healers’ services (81, 30.7%), and traditional Chinese medicine (72, 27.3%). Common reasons for use of traditional medicine in maternity were pregnancy-related symptoms, well-being during pregnancy, postnatal health conditions, and maternal depression. Age ≥ 35 years (odds ratio [OR], 16.5; 95%confidence interval [CI], 6.58–41.5; P < .001), lower educational level (OR, 24; 95% CI, 8.18–71.1; P < .001), parity (OR, 7.3; 95% CI, 1.22–42.81; P = .029), and lower income (OR, 2.7; 95% CI, 1.23–5.83; P = .013) were associated with an increased use of traditional medicine for maternal well-being. Conclusions: Our survey indicates that traditional medicine is retained as an important form of health care among African migrant women in Australia. It is important that main stream health professionals be aware of the widespread use of traditional therapies among African migrant women. (4042) Acupuncture in the Treatment of Pain in Patients With Sickle Cell Disease Thais Salles Araujo, MD1, Stela Cezarino de Morais, MD2, Felipe Caldas de Oliveira, MD2, Maria Stella Figueiredo, MD2 and Marcia Lika Yamamura, MD, PhD2 1Universidade Federal de Minas Gerais, Belo Horizonte, Brazil 2Unifesp, Sao Paulo, Brazil Abstract Purpose: Sickle cell disease (SCD) is the genetic hematologic disease most prevalent in the world. Individuals with SCD can have acute pain crises or chronic pain as aseptic necrosis. The medical literature about the use of acupuncture in these patients is very scarce. Results: 26 patients with SCD were assisted, with 28 complaints, because a patient presented pain in three different places simultaneously. The median intensity before acupuncture by ASP was 7 (2 to 10); 43% of the pains had until 7 days long. All showed reduction in pain intensity, and 86% were asymptomatic after the medical attendance. Conclusions: Acupuncture was beneficial to all patients, by reducing or eliminating pain. It is an analgesic tool more lasting than any conventional medication. A study with a control group would be necessary to increase the power of evidence of the effectiveness of acupuncture in patients. (4043) What Do Academic Physicians and Trainees Know About Botanicals? A Pilot Study to Explore Knowledge and Attitudes in a University Setting Min Jung Kim, PhD1, Jordan Albano1 and Mary P Guerrera, MD, FAAFP1 1Farmington, Connecticut Abstract Purpose: Over 80% of people living in developed countries use some form of complementary medicine, including botanicals; however, studies have demonstrated that a majority of physicians do not ask their patients about supplement use, and if they do, are largely unaware of the botanical’s use or potential risks or benefits. To bridge this gap, an educational module was developed with the purpose of assessing and educating physicians and residents about botanicals at our Academic Health Center. Five commonly used botanicals were selected: garlic, gingko biloba, cranberry, St. John’s wort, and black cohosh. Using this module, our study was conducted to determine the baseline knowledge of botanical medicine among physicians and to assess the efficacy of the module to improve upon participants’ understanding. Results: Over 30 physicians completed the surveys. We had five multiple choice questions with single best answers that assessed knowledge about the five botanicals. The Binomial test was used to assess the difference between pre- and postbotanical education exposure, and statistically significant differences are observed across the five questions. Two questions regarding attitudes about botanicals and knowledge of evidence-based resources were analyzed using a Wilcox Rank Sum test which also demonstrated statistical significance. Conclusions: Our results show that a brief educational module was successful in educating physicians about botanicals. Findings also emphasized that although physicians tend to see botanicals as an important topic to understand, they lack knowledge of this field. This module could potentially serve as a catalyst for UConn’s evolving medical school curriculum. (4044) Beyond Conventional Therapy in Child Neurology Els Peeters, MD1, Rianne Boeters-van Kester, PA1 and Ines A von Rosenstiel2 1Hagaziekenhuis/Juliana Children’s Hospital, The Hague, The Netherlands 2Rijnstate Hospital, The Hague, The Netherlands Abstract Purpose: Investigations in America and Canada revealed that the use of complementary therapies in children was approximately 1 in every 10 children. In children who have chronic conditions, this percentage is even higher till more than 50%. In paediatric neurology, there are a lot of children with chronic diseases and more and more parents ventilate the wish of reducing frequency and duration of taking medication. There are also more questions of how to prevent specific conditions and reduce severity of the disease from a holistic perspective. Results: Thirty-five children in the age of 0 till 17 years were seen. Main complaints were headaches, sleep disorders, epilepsy, chronic fatigue, behavioural disorders, tics and autism. Every parent and child were advised about healthy food and life style. Different interventions were discussed resulting in a top 5 therapies: stress reducing therapies, supplements, cognitive behavioural therapy, emotional freedom technique, and hypnotherapy. Of those 35 children, 5 reported no benefit of the intervention and 14 definitively improved. Conclusions: Overall, we noticed that parents and children appreciate the innovative integrative medicine approach in child neurology, stressing the need to discuss different forms of CAM strategies in ameliorating the well-being of the child. The clinical evidence is growing for many complementary modalities and they warrant consideration for inclusion into treatment plans. (4047) Level of Stress in Medical Students Renato Leca1, Alana D Araujo1, Adriana W Campos1, Andreza R Andrade1, Carolina Guimaraes1, Julia F Pellegrim1, Adelle B Abdulmassih1, Fernando A Fonseca, PhD1 and Ana Paula M Watanabe1 1Faculdade de Medicina do ABC, Santo Andre, Brazil Abstract Purpose: The emotional burden and responsibilities resulting from medical training make medical students more susceptible to presenting symptoms related to chronic stress, psychiatric disorders, and even suicides. From this situation, we evaluated the level of stress in medical students from the Faculdade de Medicina do ABC, Brazil, from all grades, to measure the possible impact of high hourly loads with intense study pace of medical graduation on the mental health of these students. Results: A total of 98 medical students from the Faculdade de Medicina do ABC, Brazil, were evaluated, being 81% women and 19% men, aged between 17 and 34 years, with a mean age of 21.92 years. Of these students, 90% considered themselves having high or very high stress and 69% reported at least one episode of stress in the month before the survey. Thirty-nine percent considered themselves to be tired or very tired and 86% slept less than 8 h per night on average, with 40% restful sleep. On the other hand, 75% considered having a good memory and only 22.4% were sedentary. The salivary cortisol tests corroborated the data of stress levels from the questionnaires. Conclusions: The results of the salivary cortisol analysis and questionnaires evidenced the high level of stress that medical students present and adequate strategies should be developed to mitigate this problem. (4048) Efficacy of Bee Venom Acupuncture for Chronic Low Back Pain: A Randomized, Double-Blinded, Sham-Controlled Trial Byung-Kwan Seo, PhD1, Ojin Kwon, PhD2, Dae-Jean Jo, MD, PhD3, Kyungsun Han, PhD2 and Jun-Hwan Lee, KMD, PhD2 1Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea 2Korea Institute of Oriental Medicine, Daejeon, Republic of Korea 3Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea Abstract Purpose: Bee venom acupuncture (BVA) is an effective treatment for chronic low back pain (CLBP) through the pharmacological effects of bee venom and the simultaneous stimulation of acupoints. However, evidence of its efficacy and safety in humans remains unclear. Results: After 3 weeks of the treatment, significant improvements were observed in the bothersomeness, pain intensity, and functional status in the BVA group compared with the sham group. Although minimal adverse events were observed in both groups, subsequent recovery was achieved without treatment. Conclusions: Consequently, our results suggest that it can be used along with conventional pharmacological therapies for the treatment of CLBP. (4049) A Meta-Analysis of the Effect of Sijunzi Decoction on Chemotherapy-Induced Nausea and Vomiting Liqiong Wang, PhD1, Chunhui Wang, PhD1, Xiaohua Pei, PhD2 and Xinyan Jin, PhD1 1Beijing University of Chinese Medicine, Beijing, China 2Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: Chemotherapy-induced nausea and vomiting (CINV) is a common adverse event associated with anticancer treatment. Sijunzi decoction, one of the most classic decoctions, is used to treat CINV, although we do not know how effective it is in treating CINV. Results: We included 15 trials including sijunzi decoction compared with no treatment or adding an emetic in both groups in a total 1155 participants with CINV. For the incidence of WHO III-IV degrees, sijunzi decoction plus an emetic group benefits more than the emetic group (N = 6, n = 468, RR = 0.41, 95% CI 0.31–0.55, I2 = 0%, fixed effect model, moderate-quality evidence). There is no clear evidence between sijunzi decoction group and no-treatment group. For the incidence rate of CINV, there is no difference between sijunzi decoction plus an emetic group and the emetic group. There is a significant reduction in sijunzi decoction group comparing with no-treatment group (N = 3, n = 317, RR = 0.52, 95% CI 0.35 to 0.77, I2 = 0%, fixed effect model, very low-quality evidence). Conclusions: Sijunzi decoction plus an emetic could decrease the incidence rate of WHO degrees III-IV. Sijunzi decoction may offer some benefit in terms of decreasing the incidence of CINV. There is insufficient evidence to demonstrate whether sijunzi decoction or sijunzi decoction plus an emetic are effective in the incidence rate of CTCAE degrees III-IV, and the evidence is too limited to make any confident conclusion. The quality of most evidence is very low for both comparisons. The main limitations are risk of bias, poor reporting, and inconsistency. We need high-quality randomized controlled studies investigating the effects of sijunzi decoction upon CINV. (4051) Comparative Effectiveness of Cheonwangbosimdan (Tian Wang Bu Xin Dan) Versus Cognitive-Behavioral Therapy for Insomnia of Cancer Patients: A Protocol for Randomized Parallel-group Pilot Trial O-Jin Kwon, PhD1, Sun-Young Moon1, Ui-Min Jerng, KMD, PhD2, Seong Woo Yoon, KMD, PhD3, So-Young Jung, BS1, Jee Young Lee, KMD, PhD3, Won-Chul Shin, MD, PhD3, Jung-Ick Byun, MD, PhD3 and Jun-Hwan Lee, KMD, PhD1 1Korea Institute of Oriental Medicine, Daejeon, Republic of Korea 2Sangji University, Wonju, Republic of Korea 3Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea Abstract Purpose: Cancer patients have two times higher prevalence of insomnia than that of healthy populations. Although cancer-related sleep deprivation can aggravate the rehabilitation of cancer treatment and quality-of-life, cancer-related insomnia has been cared with less attention. Pharmacotherapy and cognitive behavioural therapy-insomnia (CBT-I) are jointly undergone to insomnia patients. However, pharmacotherapy can be partially used to short-term insomnia patients, and CBT-I needs skilled physicians. Cheonwangbosimdan is a Korean herbal medicine generally used to relieve sleep deprivation, anxiety and palpitation. There are few prior studies to examine the effect of Cheonwangbosimdan on cancer sleep deprivation, whereas trials of other primary insomnia and secondary insomnia with hyperthyroidism were performed. Purpose of this study is to examine the effectiveness and safety of Cheonwangbosimdan to cancer patients. Conclusions: This study will be the first randomized controlled pilot trial to observe the effectiveness and safety of Cheonwangbosimdan on cancer patients’ insomnia by comparing with CBT-I. It can contribute to attentive care to cancer patients’ insomnia. (4053) Preclinical Safety Evaluation of Hwanglyeonhaedok-tang, a Traditional Herbal Formula: Acute, Sub-chronic Toxicity and Genotoxicity Studies Seong Eun Jin, MS1, Mee-Young Lee, PhD1, Chang-Seob Hyekyung Ha, PhD1, Hyeun-Kyoo Seo, PhD1 and Shin, OMd, PhD1 1Korea Institute of Oriental Medicine, Daejeon, Republic of Korea Abstract Purpose: Hwanglyeonhaedok-tang (Huang-Lian-Jie-Du-Tang, Oren-gedoku-to) has been used for the treatment of inflammatory, gastrointestinal, and cardiovascular diseases. In the present study, it evaluated the toxicity of Hwanglyeonhaedok-tang water extract (HHT). Results: We found no mortality and no abnormality in clinical signs, body weight, and necropsy findings for any of the animals in the acute toxicity study, following oral administration of HHT. However, there were significant changes in urinalysis after 2000 mg/kg/day HHT treatment for both sexes in the sub-chronic toxicity study. In male and female rats, 750 and 2000 mg/kg/day HHT treatment decreased the number of red blood cells and increased reticulocyte. Histopathological examinations revealed stomach mucosal erosion in female rats (2000 mg/kg/day). In the Ames test, the number of revertant colonies with the Salmonella typhimurium TA1537 strain and S9 mix increased in a dose-dependent manner. HHT significantly increased the number of structural chromosome aberrations in 6 h or 22 h incubation without S9 mix. In the micronucleus test, no significant increase was observed in micronucleated polychromatic erythrocytes, and no significant decrease was observed in polychromatic to total erythrocytes. Conclusions: The 50% lethal dose of HHT is greater than 2000 mg/kg body weight in rats. The no-observed adverse effects level were established for 750 mg/kg HHT in rats of either sex. The genotoxicity results indicate that HHT might be genotoxic, based on both the Ames and chromosome aberration tests. (4054) Yoga-Therapy for Rheumatoid Arthritis: Rapid Improvement in Proms Tina Cartwright, PhD1, Kofi Annie, PhD2, Vidhi Sadana, BA (Hon)2 and Bernard Colaço, MBChB FRCP2 1University of Westminster, London, UK 2Central Middlesex Hospital, LNWHT, London, UK Abstract Purpose: Rheumatoid arthritis (RA) is a long-term condition that results in inflammation of joints resulting in comorbidities including mood disorders leading to poor quality-of-life. Multidisciplinary interventions such as cognitive behavioural therapy and physiotherapy are routinely used but with limited evidence on functional outcomes and quality-of-life (QOL). Group yoga classes showed little impact in mental and QOL measures. Our study investigated RA patients’ experiences of individualised yoga therapy, a multi-modal, multi-target intervention, in terms of its acceptability and perceived impact on patient outcomes and behaviours. Results: Ninety-eight of 100 sessions were attended by participants. Qualitative findings indicated that considerable value was placed on therapeutic function of the consultation, of being listened to and receiving advice on concerns. Therapeutic mechanisms appeared to reflect tailored physical practices alongside psychosocial techniques, which promoted psychological well-being and increased perceptions of control and self-efficacy. Several reported reductions in their medication and broader benefits such as improved sleep, mood and energy. All but one participant reported positive changes to their RA symptoms, including pain reduction, greater mobility and joint flexibility. Conclusions: This novel pilot YT intervention was positively received by patients with RA, with high levels of adherence to both the course of treatments and the tailored home practice. The results suggest that yoga therapy has potential as an adjunct therapy to improve RA symptoms, increase self-care behaviours and address negative mood. (4055) Self-Reported Effects of Energy Healing: A Prospective Cohort Pilot Study in the Practitioner’s Office Trine Stub, PhD1, Olav Knudsen-Baas, MD2, Anne H Udal, PhD, MD2 and Agnete E Kristoffersen3 1UiT The Arctic University of Norway, Tromsø, Norway 2Hospital of Southern Norway, Arendal, Norway 3The National Research Center in Complementary and Alternative Medicine, Tromso, Norway Abstract Purpose: The purpose of this study was to map the symptoms the participants reported when visiting a healer for the first time and to evaluate the subjectively experienced benefits from the healing sessions. Results: The participants who visited the healers in this study were manly women (80%) with chronic disease (82%) with pain, fatigue, and/or psychological problems as main complaints. They experienced an improvement in symptoms, well-being, and activity level of approximately 50% regardless of the nature of the complaints. Women reported more improvement than men, and the change from baseline was found after an average of 4.1 treatment sessions. Forty percent of the participants reported adverse effects, which occurred directly after the healing sessions, generally lasting for less than 1 day. Conclusions: The study participants reported substantial improvement of, and major reduction of the burden of symptoms, improved well-being and activity level after healing treatment. Due to the pilot nature of the study, no interpretations about specificity of the descriptive results or mechanisms of effect can be made. (4057) Hatha Yoga for Chronic Pain in Patients Receiving Methadone Maintenance Treatment: A Pilot Study Lisa Uebelacker, PhD1, Donnell Van Noppen, BA2, Genie Bailey, MD3, Ana M Abrantes, PhD1, 2 and Michael Stein, MD4 1Brown University and Butler Hospital, Providence, Rhode Island 2Butler Hospital, Providence, Rhode Island 3Stanley Street Treatment and Resources, Fall River, Massachusetts 4Boston University School of Public Health, Boston, Massachusetts Abstract Purpose: Purpose: Chronic pain is a significant problem for many people receiving opioid agonist treatment for opioid use disorder. We adapted existing yoga programs for chronic pain and conducted a pilot RCT to assess acceptability and feasibility in people enrolled in methadone maintenance. Results: We recruited 20 participants in 6.5 months, meeting our target recruitment rate. Ninety percent of participants completed an endpoint assessment. There were no serious adverse events related to study participation. Self-report measures of credibility, acceptability, and satisfaction exceeded pre-set cut-offs for both arms. Participants who attended more than 1 yoga class reported practicing yoga at home at least twice per week for at least 75% of the weeks for which they provided data. The only benchmark we did not meet was class attendance. Although rates improved over time as we made modifications, only 5 of 10 people assigned to yoga attended 7 classes or more (of 12 possible). We examined reasons for poor attendance. One person went to jail right after randomization, one experienced a severe pain exacerbation before attending classes, and one had ongoing health problems including influenza and gastrointestinal distress. Finally, two participants seemed fearful that yoga might increase pain rather than help. Conclusions: Yoga seems acceptable and is readily adopted by some people with chronic pain who are taking methadone. However, health problems, justice system involvement, and fear of pain may interfere with participation. Next steps include a consideration of ways to address the problem of fear of pain in this population. (4059) Limitations to Assessment of Acupuncture in the Military Health System Avni Patel, MPH1, Megan Vaughan, BSN, RN, CCRP1, Tracey Perez Koehlmoos, PhD, MHA2 and Cathaleen A Madsen, PhD1 1Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, Maryland 2Uniformed Services University of the Health Sciences, Bethesda, Maryland Abstract Purpose: “Big Data” provides a means of investigating patterns of usage and outcomes in health care. However, Big Data is rarely used to investigate Integrative Medicine (IM), despite calls for this type of research. This study examines a single IM modality, acupuncture, in a universally insured population, and illustrates several challenges with this approach to investigation of IM. Results: A total of 15 761 recipients of acupuncture were identified in the MHS. While demographic and diagnostic information was available, significant obstacles to analysis included 13% missing race data, 9.5% ill-defined diagnoses, insufficient procedural codes to differentiate between different modalities of acupuncture or to separate acupuncture from non-cupuncture modalities in a common therapeutic category (eg, “infrared”), and inability to determine primary from adjunct therapy. Conclusions: Missing data, inefficient coding, and insufficient granularity represent system-wide obstacles to big data investigation of acupuncture in the MHS, and likely to other systems using standard coding. Additional electronic notation is recommended to enable full analysis. Disclaimer: The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views, assertions, opinions, or policies of the Uniformed Services University of the Health Sciences; the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.; the Defense and Veterans Center for Integrative Pain Management; the Department of Defense; or the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. (4061) Does the Presence of Integrative Medicine Curriculum Enhance Residency Recruitment? Patricia Lebensohn, MD1, Victoria Maizes, MD1, Mei-Kuang Chen, PhD1, Hilary McClafferty, MD1, Mari Ricker, MD1 and Audrey J Brooks, PhD1 1Tucson, Arizona Abstract Purpose: The University of Arizona Center for Integrative Medicine Integrative Medicine in Residency (IMR) program began in 2008 as a feasibility pilot in 8 Family Medicine residencies. Since the successful pilot, the IMR program is now in use in 58 Family Medicine residencies, 4 internal medicine, 2 psychiatry, 2 preventive medicine, and 1 obstetrician–gynecologist residencies. The Pediatric IMR began in 2013 in 5 pilot sites and is now in 11 sites. A potential benefit of the IMR program in residencies is that it may enhance recruitment at those sites. This study surveyed incoming residents at IMR sites to examine the role of the IMR program as a recruiting tool. Results: 253 residents completed the survey (29% response rate). The majority were Family Medicine (n = 173; 68%) or pediatric (n = 66; 26%) residents. Almost half (45%) had personal experience with IM, 36% had taken an IM elective in medical school, and 31% had taken a required IM course. Two thirds (65%) were aware of the IMR curriculum when applying to the residency and 57% discussed the IMR when interviewing. IMR was rated as one of the main decision criteria in applying (25%), interviewing (22%), and ranking (31%). Location was the most frequently cited criteria (81% applying, 90% interviewing, 79% ranking). Most residents were interested in learning (68%) and applying IM (63%). Family Medicine residents were significantly more likely to be aware of the IMR curriculum than pediatric residents (81% vs. 21%), discuss it when interviewing (73% vs. 10%) and rated the importance of the IM curriculum in applying and ranking higher (P < .001). However, there was no difference between the groups of interest in learning or applying IM. Conclusions: This study examined the potential impact of the IMR curriculum as a recruitment tool. A majority of residents were aware of the presence of the IMR program at the residency site and had strong interest in learning and applying IM. However, in the Family Medicine programs where there is a longer IMR history, awareness and importance of IMR in residency site selection was much higher indicating the potential of an IMR program to enhance recruitment. (4062) Capturing the Ineffable: Development of the Nondaul Awareness Dimensional Assessment Eric Garland, PhD1, Adam W Hanley, PhD1 and Yoshio Nakamura, PhD1 1Center on Mindfulness and Integrative Health Intervention Development, Salt Lake City, Utah Abstract Purpose: Nondual awareness is an altered state of consciousness that is well documented in religious and meditative traditions. Yet, no standardized method of measuring nondual awareness currently exists. To address this gap, we developed and validated two forms of the Nondual Awareness Dimensional Assessment (NADA). The first form captured dispositions toward nondual awareness (NADA-T) and the second form captured states of nondual awareness (NADA-S). Results: PCA revealed 2 interpretable dimensions of the NADA-T: self-transcendence and bliss. B-ESEM indicated that both NADA-T dimensions were components of a second-order nondual awareness construct. Positive correlations were observed between the NADA-T and theoretically aligned constructs, such as interdependent self-construals and decentering. Mindfulness practitioners reported higher NADA-T scores than nonpractitioners, and practice frequency was positively correlated with NADA-T scores. Finally, a mindfulness induction was observed to increase nondual awareness relative to an active listening task. Conclusions: The NADA-T and -S were constructed as a means to facilitate quantitative investigation of nondual awareness. Our findings indicate that the NADA-T and -S are valid measures, and that continued use and refinement of these instruments may provide useful insights into the prevalence, correlates, mechanisms, and consequences of nondual states of awareness and their relations to health and illness. Systematic, quantitative investigation of nondual awareness has much to contribute to the emerging field of contemplative science. (4063) How Do Yoga and Meditation Influence the Relationship Between Negative Life Events and Depression? Romy Lauche, PhD1, Holger Cramer, PhD2, Dennis Anheyer, MA2, Jon Adams, PhD1 and David Sibbritt, PhD1 1University of Technology Sydney, Sydney, Australia 2University of Duisburg-Essen, Essen, Germany Abstract Purpose: Yoga and meditation have been gaining popularity worldwide. While benefits have been reported for physical and mental health, the mode of action is vastly unknown. Previous research has suggested that yoga/meditation may act via the reduction of stress, one of the major risk factors for depression. Therefore, this study aims to determine whether yoga/meditation moderates the relationship between negative life events and depression. Results: Stepwise analyses revealed that perceived stress partially mediated the association between negative life events and depression. Social support moderated the paths life events—stress, and stress—depression, while no such moderation was found for yoga/meditation. Instead yoga/meditation use was found to moderate the direct path between negative life events and depression. Contrary to yoga/meditation use, no such moderating effect was found for physical activity. Conclusions: This study found that yoga/mediation use did not influence depression through the stress path, instead yoga/mediation was found to dampen the influence of negative life events on depression directly. More research on the mechanisms of yoga are warranted. (4065) Development of an Attention Control Group for Tai Chi in Older Adults With Chronic Low Back Pain Karem J Sherman, PhD, MPH1, Manu Thakral, ARNP, PhD1, Emily Bandy, MSn2, Judith Turner, PhD3 and Elizabeth Phelan, MD3 1Kaiser Permanente Washington, Seattle, Washington 2Seattle University, Seattle, Washington 3Seattle, Washington Abstract Purpose: Attention control groups are designed to control for “nonspecific” effects in nonpharmacological studies. In this presentation, we describe the systematic development of an attention control group for a study of tai chi in older adults with chronic back pain. Results: We did develop a 24-session course, lead primarily by a nursing student who was also a social worker, but with guest lectures from several others. All classes had short power point presentations as well as questions designed to engage patients in discussion. The course material was quite comprehensive and included various physical and mental health difficulties (depression, sleep, and bladder problems), prevention (fall prevention, brain health flu, and pneumonia prevention), making medical care safer (using medications safely and communication with the health care provider), changes as a result of aging (nutrition and osteoporosis), and special issues as a result of aging (safe driving, caregiving, and social support). As of this submission, 9 classes had been held. In the attention control group, 6 of 12 participants attended 7 or more classes versus 9 of 13 in Tai Chi. Classes will be completed at the end of March, and then formal comparisons will be made between attendance for the two interventions. Conclusions: We describe an attention control group that may meet the needs of complex mind–body therapies, though until the classes are completed, this cannot be known for sure. (4067) Identification of Circulating MicroRNAs Associated With Sleep Disorder Using Next-Generation Sequencing Seongwon Cha, PhD1 and Boyoung Lee, BA1 1Korea Institute of Oriental Medicine, Daejeon, Republic of Korea Abstract Purpose: Mibyeong (or subhealth) from traditional East-Asian medicine is a nondisease physiological state that presents medically unexplained symptoms. One of main cause of Mibyeong would be sleep disorder. It is important to prevent severe form of sleep disorder such as chronic insomnia, leading to lower performance at work, a higher accidental risk, depression, and so on. Circulating microRNA (19–24 nucleotides) exists as a stable-form in body fluid including serum (plasma), cerebrospinal fluid, and saliva and has potential as a biomarker of cancer, cardiovascular disease, etc. Therefore, we focused on circulating microRNA (miRNA) as a biomarker of sleep disorder, and aimed at identifying dyssomnia-associated serum miRNAs using next-generation sequencing (NGS). Results: Totally 63 miRNAs from individuals with sleep disorder compared to healthy individuals showed differential serum levels (over 2-fold, P < .05). Interestingly, the number of identified miRNAs was clearly distinguished between men and women: 8 miRNAs in men and 58 miRNAs in women. Conclusions: Gender difference in miRNA levels associated with sleep disorder may reflect that women usually suffer from sleep disturbance more frequently than men. Further study to confirm the dyssomnia association of NGS miRNAs in other independent groups would be necessary. (4071) Mindfulness-based Interventions for DSM-5 Anxiety Disorders—A Systematic Review and Meta-analysis Pascal Breilmann1, Heidemarie Haller, MSc1, Holger Cramer, PhD1 and Gustav Dobos, MD PhD1 1University of Duisburg-Essen, Essen, Germany Abstract Purpose: This meta-analysis aimed to systematically review the evidence on mindfulness-based interventions in patients with DSM-5 anxiety disorders. Results: The literature search revealed 14 RCTs including 1159 patients with generalized or social anxiety disorder, panic, phobias, or anxiety disorder NOS. The overall risk of bias was unclear, except for mostly low detection bias, attrition bias, and other bias. Compared to TAU, mindfulness-based interventions showed significant short-term effects on clinician-rated (3 RCTs; SMD = −2.51; 95% CI = [−4.24¦−0.77]; I2 = 94%) and patient-rated anxiety (9 RCTs; SMD = −0.86; 95% CI = [−1.16¦−0.55]; I2 = 71%). While clinician ratings all based on ACT studies, subgroup analyses of patients-rated effects revealed significant SMDs for ACT, MBCT, and MBSR with considerable heterogeneity only between the MBSR studies. Patient-rated depression (9 RCTs; SMD = −0.89; 95% CI = [−1.46¦−0.50]; I2 = 87%) and quality-of-life (6 RCTs; SMD = 0.67; 95% CI = [0.14¦1.21]; I2 = 86%) also significantly improved in the short term. In comparison to psychotherapeutic interventions such as cognitive-behavioral therapy, education and relaxation, effects of ACT, MBCT, and MBSR were comparable for all outcomes in the short term, 6 and 12 months after randomization. Adverse events were reported insufficiently. Conclusions: This meta-analysis suggested significant greater anxiolytic effects of mindfulness-based interventions against TAU and comparable effects in comparison to standard psychotherapeutic interventions up to 12 months. However, risk of bias was often unclear and heterogeneity was considered particularly in MBCT and MBSR analyses, which limits the conclusions. (4074) Herbal Medicine (Danggui Liuhuang Decoction) for Treating Menopausal Symptoms: A Systematic Review of Randomized Clinical Trials Hye Won Lee, PhD1, Ji Hee Jun, MSc1, Junhua Zhang, MD, PhD2, Fengwen Yang, MD, PhD2 and Myeong Soo Lee, PhD1 1Korea Institute of Oriental Medicine, Daejeon, Republic of Korea 2Tianjin University of Traditional Chinese Medicine, Tianjin, China Abstract Purpose: Danggui Liuhuang (DLH) decoction is a traditional herbal medicine that is widely used in East Asia to treat menopausal symptoms. Most of the available clinical trials that investigated DLH decoction have been included in this review. The purpose of this review was to evaluate the effectiveness and safety of DLH decoction in the treatment of menopausal symptoms. Results: Eight RCTs showed better effects of modified DLH decoction than of Western medicine on treatment effects and the Kupperman index. Seven RCTs tested the effects of modified DLH decoction in comparison with those of Western medicine on treatment effects and favorable treatment effects of modified DLH decoction. Moreover, our meta-analysis also showed significant improvements in treatment effects (n = 482, RR:1.27, 95% CI: 1.07 to 1.52, P = .007) with high heterogeneity (I2 = 84%). Two RCTs compared the DLH decoction with Western medicine using the Kupperman index. However, our meta-analysis failed to show significant improvement (n = 270, MD: −4.67, 95% CI: −13.28 to 3.95, P = .29). Conclusions: This systematic review and meta-analysis provide preliminary evidence of the superiority of DLH decoction over other therapies for treating menopausal symptoms. Unfortunately, the level of evidence is low due to small sample sizes and low quality of reporting. (4076) Aromatherapy for Managing Pain in Primary Dysmenorrhea: A Systematic Review of Randomized Placebo Controlled Trials Hye Won Lee, PhD1, Myeong Soo Lee, PhD1 and Mohamed Khalil, MD, PhD2 1Korea Institute of Oriental Medicine, Daejeon, Republic of Korea 2National Center for Complementary and Alternative Medicine, Ministry of Health, Riyadh, Republic of Korea Abstract Purpose: Aromatherapy, the therapeutic use of essential oils, is often used to reduce pain in primary dysmenorrhea. The aim of this study was to summarize and critically assess the available evidence regarding the efficacy of aromatherapy in managing pain in primary dysmenorrhea. Results: We identified 382 potentially relevant studies, 19 of which met our inclusion criteria All of the trials reported superior effects of aromatherapy for pain reduction compared to placebo (n = 1787, standard mean difference (SMD): −0.91, 95% CI: −1.17 to −0.64, P < .00001) with high heterogeneity (I2 = 88%). A subanalysis for inhalational aromatherapy for the alleviation of pain also showed superior effects compared to placebo (n = 704, SMD: −1.02, 95% CI: −1.59 to −0.44, P = .0001, I2 = 95%). With regard to aromatherapy massage, the pooled results of 11 studies showed favourable effects of aromatherapy massage on pain reduction compared to placebo aromatherapy massage (n = 793, SMD: −0.87, 95% CI: −1.14 to −0.60, P < .00001, I2 = 70%). Oral aromatherapy had superior effects compared to placebo (n = 290, SMD: −0.61, 95% CI: −0.91 to −0.30, P < .0001, I2 = 0%). Conclusions: Our systemic review provides a moderate level of evidence on the superiority of aromatherapy (inhalational, massage or oral use) for pain reduction over placebo in primary dysmenorrhea. (4079) What Should Massage Education Do More of, Different, Start, and Stop? Massage Education Stakeholder Views From the 2017 Alliance for Massage Therapy Educational Congress Jasmine L Dyson-Drake, BS1, Diane Mastnardo, BS2 and Niki Munk, PhD, LMT1 1Indiana University School of Health and Rehabilitation Sciences, Indianapolis, Indiana 2Massage of Northern Ohio Practice Based Research Network/MetroHealth Case W, Cleveland, Ohio Abstract Purpose: An Education Futures Forum held during the 2017 Alliance for Massage Therapy Education’s Educational Congress systematically gathered massage education stakeholders’ opinions through a World Café modeled exercise. Results: Eighty-five to 91 attendees participated in the 3 breakout sessions resulting in 674 comments with 3744 assigned value points. The top 5 scoring comments from each room per session (N = 45) determined stakeholder’s most critical views. Stop comments made up the smallest total comments proportion (19%) yet largest top scoring comment proportion (36%) potentially highlighting unified frustration for various massage education practices. Comparatively, start comments made up 26% of total comments but the smallest highest scoring proportion (18%) perhaps suggesting stakeholders feel it more important to improve what is already being done rather than beginning new endeavors in these areas. Conclusions: Stakeholder views were systematically gathered in a large conference setting for organization, analysis, and dissemination to inform field decision-making. (4081) Development, Implementation, Assessment, and Refinement of an Evidence-based, Multidisciplinary, Graduate Integrative Medicine Program Leigh A Frame, PhD, MHS1, Whitney Milhouse, MS1, Andrew Heyman, MD, MHSA1 and Leslie Davidson, PhD, OT/L, FAOTA1 1Washington, DC Abstract Purpose: Graduate level education in the area of Integrative Medicine (IM) and health is emerging across a number of institutions in the United States including the University of Arizona, Duke University, and the University of California, San Francisco. The popularity of an IM approach can be linked to the personalized medicine movement as well as sustainability issues such as prevention of chronic disease and provider burnout. The goal of this poster is to outline the process of development, implementation, assessment, and refinement of evidence-based, multidisciplinary IM programs at the George Washington University in the School of Medicine and Health Sciences. Results: Success in these programs has been dependent on the adoption of an interprofessional approach, emphasizing current training needs of practitioners across the IM spectrum. Emerging and robust scientific evidence is used throughout the curriculum to ensure clinical practice efficacy. Upon completion of the program, students demonstrate competency in legal/ethical issues surrounding these areas of practice. Admissions into the program have grown by at least 30% over the past 2 years indicating a demand for this type of academic work. Conclusions: The adoption of comprehensive content, contributors, and instructors, who are leaders in the field, has been the foundation for the development and sustainability of this education program. This process can be adopted by other institutions who are seeking to expand their footprint to IM education. (4084) Adverse Reactions of Blood-lipid Lowering Chinese Patent Medicine: Data From ADR Monitoring Center in China Xiatian Zhang1, Baoyi Shao1, Ying Zhang, PhD1, Di Wang1 and Jianping Liu, PhD1 1Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: The incidence and prevalence of hyperlipidemia in China were still high, causing huge medical and economic burden. Chinese patent medicine (CPM) was widely used as monotherapy or combination with western medicine in clinical practice to control blood lipid. As the marketing approval from China Food and Drug Administration was based on the results of randomized controlled trials from phases I to III, the analysis of safety data of post marketing for CPM was more important for learning about the adverse reactions (ARs) in real world. This study aimed to explore the incidence of ARs for commonly used CPMs which registered in database of ADR monitoring center. Results: Totally, 122 212 cases were recorded as adverse reactions in the database. There were 42 326 cases of ARs caused by 184 CPMs. The top 5 kinds of CPMs were Xuezhikang capsule (n = 135), Tongxinluo capsule (n = 16), breviscapine injection (n = 7), tea pigment capsule (n = 7), and puerarin injection (n = 6). The main types of ARs were nausea (n = 113), bloating (n = 90), dizziness (n = 40), rash (n = 39), and diarrhea (n = 37). Compared with the selection of CPMs and the types of ARs, the binary logistic regression showed that compared with other lipid-lowering CPMs, Xuezhikang capsule had relatively lower ORs to ARs. Conclusions: Post-marketing ADR monitoring of lipid-lowering CPMs is important not only to help physicians and patients optimize treatment interventions but also to help policymakers allocate medical resources efficiently. In addition, it can provide reference for the design and evaluation of future studies. (4085) Patients’ Participation on Their On-Site Review of Doctors’ Notes: Physicians’ OpenNotes Experiences in a Pain Clinic Victor Wang, MD, PhD1, Christopher Gilligan, MD, MBA1, Ashish Bhandari, MBBS1 and Manasi Bhandarkar, MBBS1 1Brookline, Massachusetts Abstract Purpose: Inviting patients with chronic pain to read their doctors’ visit notes via secure electronic portals may empower them and improve their understanding of their health condition. However, sharing the clinician’s perspective on the psychosocial contributors to a patient’s pain via transparent medical records could potentially lead to conflicts between patients and providers. Mirroring the OpenNotes study, we investigate and describe the effects of increased clinic visit note transparency on physician experience in a large outpatient pain medicine clinic. Results: Pain Medicine Physician and Patient Participation: Of the 10 BIDMC pain medicine physicians who started using OpenNotes, 9 completed the study. All the participants who completed the 6-month study submitted pre- and postintervention surveys. The participants also attended pre- and postintervention debriefing sessions to discuss issues not directly covered in the survey. Since this study focused on experiences of pain medicine physicians, no patients were contacted during the study period. Pain Physician Experiences: Of the 9 physicians who responded to the postintervention survey, 5 estimated that conversations about OpenNotes occurred less than once per month, 3 felt that patients were calling 1–3 times per month, and 1 believed their patients were calling 1–6 times per week about the notes. This represents an insignificant change from call volume prior to the intervention. Before the start of the study, the participating pain physicians were generally worried about the increasing workload that OpenNotes could bring to their practices. The postintervention surveys illustrate that the perceived workload did modestly increase. However, the increases were not as significant as these physicians originally believed they would be. Although patient experiences were not directly captured, before the intervention, 89% of the participating physicians “agreed” or “somewhat agreed” that their patients would worry more after being able to read their clinic notes. Following the intervention, 79% “agreed” or “somewhat agreed” that their patients did indeed worry more after having access to their notes. Participants were also asked to assess whether they believed that patients would request changes to their notes. In the preintervention survey, 89% “agreed” or “somewhat agreed” that patients would request changes. Following the intervention, 44.5% of the physicians reported that they received 1 request for modification per month, 44.5% reported receiving 2–4 requests per month, and 11% received more than 5 requests for changes per month. Although 33% of participants were “moderately concerned” or “very concerned” that OpenNotes would increase the average visit length, none of them felt that visit time was increased following the intervention. In the preintervention survey, 78% of providers were “moderately concerned” or “very concerned” that they would spend more time outside of scheduled visits answering questions, while 56% reported spending more time answering questions after the intervention. Another subset topic on the pre- and postintervention surveys addressed issues regarding offending patients, candid documentation, and avoidance of subjects likely to produce offense such as mental health disorders and substance abuse. Regarding offending patients, 56% of the participants were “moderately concerned” before the intervention that their notes would offend patients and 56% reported offending 1–3 patients per month after the intervention. Regarding less candid documentation, 33% of the physicians reported being “moderately concerned” or “very concerned” that their notes would be less candid before the intervention, while only 11% reported being less candid in their documentation after the intervention. Prior to the intervention, 22% of the participating pain physicians believed that they would have to change the way they address topics like mental health and substance abuse and 22% reported changing the way they address these subjects in the postintervention survey. The postintervention survey also evaluated physician perceptions of patient confusion and provider experiences using OpenNotes. Regarding patient confusion, 56% of participating physicians either “agreed” or “somewhat agreed” that their patients were confused by reading their notes, while 33% were not able to tell. When asked “Is having patients read their notes a good idea?” 67% either “agreed” or “somewhat agreed.” When given the prompt, “If OpenNotes were turned off, our physicians would…,” 56% of participants stated they “would not care,” 11% would be “somewhat pleased” and 33% claimed they would be “very pleased.” Postintervention Comments from Debriefing Sessions: The postintervention debriefing session allowed the study participants to comment on their experiences using OpenNotes. Some of the challenges of OpenNotes were as follows: changes in notes requested by patients often lacked clinical significance, documentation was targeted to nonmedically trained people which was not effective for professional communication, notes included fewer details of clinical diagnoses such as mental health and substance abuse, and notes sometimes created confusion and worry for patients over clinically insignificant matters. Some providers felt that OpenNotes could potentially help patients understand their care better but this was not formally assessed. Providers were also given the opportunity to offer feedback on OpenNotes. As this study was conducted at an academic institution, several physicians expressed frustration with the inferior quality of their trainees’ notes, feeling they were often inaccurate or poorly written. Limitations in the note writing software program also prevented the participants from directly editing a trainee’s note. Furthermore, the faculty also felt that they did not have enough time to write addenda before the clinic notes became available to patients. One asserted that “it would be better if the attending could edit a trainee’s notes.” Conclusions: This study represents the start of a journey that explores how pain medicine physicians can communicate more transparently with their patients. However, this study also raises questions about the complex effects of OpenNotes on the patient–physician interaction and how shared decision-making may be facilitated or hampered by this intervention. Thus, it motivates future research into this area to define the patient perspective and answer the question of whether changes in physician workload are quantitative or qualitative. In the future, it will be fascinating to compare patient perspectives with those of our pain medicine faculty and trainees. Despite the challenges of introducing OpenNotes in an academic setting and modestly increasing workloads, the potential benefits provided by increased transparency between patients and pain physicians, such as increased medication adherence, greater understanding of care plans, and empowering patients to improve their pain, make it imperative to explore this fundamental change in practice carefully and creatively. (4086) Trigger Point Self-Care for Chronic Neck Pain: Pilot Study Results Arash Zakeresfahani, BS1, Anthony Perkins, MS2 and Niki Munk, PhD, LMT3 1Indiana University School of Physical Education and Tourism Management, Indianapolis, Indiana 2Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana 3Indiana University School of Health and Rehabilitation Sciences, Indianapolis, Indiana Abstract Purpose: Massage is promising for chronic neck pain (CNP) but accessibility is limited due to out-of-pocket costs. Trigger points contribute to CNP and trigger point self-care (TrPtSc) may be an effective way for massage benefit to reach broad populations. This proof-of-concept/feasibility study sought to examine trigger point self-treatment effect for CNP. Results: Forty-six (n = 36 females) adults, aged 19–67 (mean = 47.6 ± 12.9) years, were enrolled. Five enrollees (n = 1 female) were excluded from the analysis due to missing data and early withdrawal resulting in N = 41. Within-group analysis indicated improved current and worst pain Visual Analogue Scale (VAS) scores for TrPtSc (P = .003; .007, respectively) and massage (P = .02, .05, respectively) groups and improved average VAS (P = .009), current 11-point pain (P = .02), and best 11-point pain (P = .018) for the TrPtSc group. TrPtSc improved current 11-point (P = .029) and VAS pain (P = .044), worse VAS pain (P = .049), and best 11-point pain (P = .004) compared to control at week 8. Conclusions: TrPtSc and massage were both effective for CNP after 4 weeks but only TrPtSc retained benefit and continued to improve at week 8. Fully powered, larger research is needed to confirm trends and determine the extent to which TrPtSc alone or combined with massage contribute to CNP’s long-term management. (4087) Treating Contact Dermatitis With Cool-reducing Method and Blood-letting Puncture – A Case Report Yuhao Wu, PhD1 and Yumin Cho, PhD2 1Chengdu University of Traditional Chinese Medicine, Chengdu, China 2Los Angeles, California Abstract Purpose: Contact dermatitis, a common allergic skin disease, usually occurs when the skin develops an allergic reaction after being exposed to a foreign substance. In modern medicine, glucocorticoids are often used for treating contact dermatitis. However, symptoms recur with medication discontinuation in some patients. The purpose of the present study was to address the effect of treating contact dermatitis by using acupuncture and blood-letting, complemented with Chinese herbal medicine. Results: After 3 months treatment, the color of the rash on cheeks fades and the rash on forehead was eliminated. No itching and burning sensation was present. There was no symptom recurrence observed during a follow-up investigation of 2 months. Conclusions: Acupuncture and bloodletting, supplemented with Chinese herbal medicine, may be an effective option in treating contact dermatitis. (4088) Randomized Controlled Trials Investigating the Association Between Dietary Pattern and High-sensitivity C-reactive Protein: A Systematic Review David Deichert, ND, ARNP1, Jamie Corroon, ND, MPH2, Courtney K Pickworth, BA3 and Ryan Bradley, ND, MPH3 1Seattle Healing Arts Center, Seattle, Washington 2Center for Clinical Consulting, Del Mar, California 3National University of Natural Medicine, Portland, Oregon Abstract Purpose: Elevated serum concentration of high-sensitivity C-reactive protein (hsCRP), a biomarker of systemic inflammation, is associated with increased risk for coronary heart disease (CHD) and cardiovascular events. Evaluation of nonpharmaceutical methods for lowering hsCRP has not been emphasized in the literature due to the efficacy of pharmacological methods (ie, statin drugs) in reducing hsCRP as well as the historically low adherence to intensive lifestyle modification. Alternatives to statins to lower serum hsCRP, including dietary modification, merit investigation. Objective: To systematically review clinical trials focused on dietary interventions and hsCRP. Results: Fifty-six manuscripts met inclusion criteria for detailed review. The value of modifications to dietary pattern for hsCRP reduction has been investigated in many populations, including those at risk for CHD, type 2 diabetes, and other chronic disease. Collectively, results suggest that the adoption of several dietary patterns may lead to clinically significant reductions in hsCRP in both healthy and diseased populations. These patterns include low fat, Mediterranean, Portfolio, Paleolithic, and the Dietary Approaches to Stop Hypertension diets. Other interventions, eg, low carbohydrate diets, have had mixed results. Conclusions: Clinical trials of dietary interventions to lower hsCRP are mixed in terms of quality, risk of bias, and findings. Despite the variability of results, randomized clinical trials to assess dietary interventions for lowering hsCRP are justified and valuable. (4089) Associations Between a Contemplative Curricula and Self-compassion in University Students Dara James, MS1, Maria Napoli, PhD1, Robin Bonifas, PhD1, Lisa Schmidt, MS1 and Jacob Szeszulski, MS1 1Arizona State University, Phoenix, Arizona Abstract Purpose: University students experience a myriad of psychosocial stressors. Studies have established that self-compassion can ameliorate negative psychological outcomes (ie, stress, depression, anxiety) while increasing positive psychological outcomes (ie, well-being, academic performance, happiness). Self-compassion combines the concepts of self-kindness, common humanity, and mindfulness; it is understood as treating oneself the way one would treat a suffering friend. Few studies have addressed the influence of academic courses on self-compassion; this study aimed to examine contemplative curricular effects (1. acknowledgement, 2. attention, 3. acceptance without judgment, and 4. choosing to respond) on self-compassion. Results: At baseline, no differences in self-compassion by race (P = .618) or age (P = .474) were noted, but significant differences by gender (males 37.2 ± 6.1; females 32.9 ± 7.6; P < .001) were present. Self-compassion increased 3.6 ± 7.9 points at posttest; changes were higher among females (5.5 ± 8.7 vs 1.6 ± 6.5; P = .001) and Caucasians (5.6 ± 8.0), followed by Latino (5.3 ± 8.3), multi-racial (1.7 ± 9.7), and Asians (.4 ± 6.0), but were not different by age (P = .716). Differences between Caucasians and Asians were significant (P = .026). Conclusions: Contemplative curricula may increase self-compassion and potentially help reduce psychosocial impacts of burdens commonly experienced among university students. Improved outcomes may have strong implications for both immediate and long-term reduced stress, enhanced well-being, and student success. Variables of culture and gender may moderate these associations and should be explored further. (4091) Does Pilot Study Always Provide Credible Parameters? Considerations on the Sample Sizes of Vanguard Trials for CAM Ying Zhang, PhD1, Jianping Liu, PhD1, Di Wang, Xun Master1, Yutong Li, PhD1 and Fei, PhD1 1Beijing University of Chinese Medicine, Beijing, China Abstract Purpose: Most of the complementary and alternative medicine (CAMs), such as Traditional Chinese Medicine, has a long application history in clinical practices but lacks empirical data to investigate the efficacy or effectiveness as an intervention for a specific disease. In recent decades, more and more randomized controlled trials of CAMs were carried out, and a pilot study is necessary to explore the feasibility, acceptability, and time schedule for the main trial. In addition, the pilot study could provide the key parameters which will be used to calculate the sample size of the main trial. However, the pilot study, in fact, often has been conducted with an arbitrary sample size. This study aims to explore the principles to determine sample size for pilot studies. Results: The factor which should be considered firstly is feasibility. Julious proposed the rule of thumb for 12 in each group, because 12 is a convenient number to be divided by 2, 3,4, 6, or even 12 and therefore could be adaptive to various block size in randomization. From the perspective of precision, iteration method was often used. Some advised from 10 to 75 for different Cohen effect size. Monte Carlo simulations were applied to explore power, and 30–60 per group were recommended in several researches. Conclusions: The study implies that using parameters without any adjustment in the pilot study will underestimate the sample size in the main trial and therefore lose the statistical power. Iterations or simulations should be done, if possible, to provide parameters with high precision and guarantee the main trial achieve ideal power. (4096) Indigo Naturalis Ointment for Plaque-type Psoriasis: A Systematic Review Hung-Jen Lin, MD, PhD1, Hung-Rong Yen, MD, PhD1 and Kuo-Feng Hung, MD1 1China Medical University Hospital, Taichung, Taiwan, Province of China Abstract Purpose: Plaque-type psoriasis is challenging to treat. Currently available treatments are limited in efficacy and often produce unfavorable side effects. A plant extract, indigo naturalis (IN), is widely used in topical ointment form for plaque-type psoriasis. The aim of this study is to evaluate the efficacy and safety of IN ointment (INO) for patients with plaque-type psoriasis. Results: In terms of efficacy, only three studies met the criteria for study design and passed a Cochrane risk of bias analysis. Sixty-four participants received INO therapy, and 55 were treated with vehicle ointment (VO). Based on this limited dataset, 64% of patients achieve more than 75% reduction in Psoriasis Area Severity Index after 8-week INO therapy, compared to 2.5% of patient in VO group. For safety outcomes, no serious or life-threatening adverse effects were found. Conclusions: There were some evidence of benefit of INO for plaque-type psoriasis, and no reported serious adverse events related to INO. However, the conclusion was limited by the small number of included trials. Future randomized controlled trials are needed to clarify the effect of INO for plaque-type psoriasis. (4098) Effect of Homeopathy Treatment for Post-traumatic Stress Disorder in Battered Women: Randomized Wait-list Controlled Trial Neha Sharma, PhD1 and Sadhana Sharma, MD2 1Warwick Research Services, Leicester, UK 2NMP Medical Research Institute, Jaipur, India Abstract Purpose: Although numerous mental health issues are associated with intimate partner violence, post-traumatic stress disorder (PTSD) is the most prevalent disorder in battered women. Traditional PTSD treatments that incorporate exposures are contradicted. Treatments exist for persons in the acute aftermath of trauma treatment do not address battered women’s ongoing threat of revictimization. To date, only cognitive behavioral therapy has been tried for battered women. To determine if treating with homeopathy could effectively diminishes symptoms of PTSD in battered women, randomized waitlist controlled trial was designed. Results: After the 3 months of treatment period, participants in homeopathy group showed significant decrease in PTSD symptoms (P < 0001). A between-group comparison at posttest revealed greater PTSD symptom reduction (P < .001) and depression (P < .001) in homeopathy group that WLC. Participants in homeopathy group reported high satisfaction with treatment and high rate of recovery. Conclusions: This is first randomized controlled trial using homeopathy for treating PTSD in battered women. Homeopathy is easily available, self-administered, feasible option that might help women cope with traumatic effect of their abuse and establish long-term well-being. (4099) Quxie Capsule Inhibits the Colon Tumor Growth Through FOXO1-Mediated Apoptosis and Immune Modulation Yan Jiang, PhD1, Yufei Yang, PhD2, Dongmei Chen, Peiying Master3 and Yang, PhD4 1Texas 2Xiyuan Hospital, Beijing, China 3Beijing University of Chinese Medicine, Beijing, China 4Houston, Texas Abstract Purpose: Traditional Chinese Medicine, such as Quxie Capsule (QXC), has been routinely used in colorectal cancer treatment in Xiyuan Hospital in China. However, the mechanism(s) underlying the effect of QXC in colon cancer still remain unclear which hampers its optimal use for the treatment of colon cancer. Forkhead box O1 (FOXO1), a transcription factor plays an important role in cell cycle, apoptosis, and immune modulation in various cancers. In this study, we aimed to examine the antitumor efficacy of QXC in mouse colon cancer and further investigated the mechanism by which QXC upregulated FOXO1 protein-mediated pathways. Results: QXC gavage to mice carrying CT26 mouse colon tumors for 2 weeks significantly reduced the average tumor weight (0.68 ± 0.41 g) compared to that in the control treated mice (1.16 ± 0.22 g, P < .05). Both Foxo1 mRNA and protein expression in tumor was increased in QXC group as opposed to that of the control. Further, QXC treatment led to elevated apoptotic regulating proteins such as Fas, Bim, and cleaved caspase-3 in tumor tissue compared with that of the control group. Intriguingly, the ratio of Th1/Th2 and its key regulator, T-bet protein, was increased while Treg/Th17 ratio and T-reg regulator, Foxp3, were reduced in QXC treated mice compared to that of the control, revealing that Foxo1 upregulated T-bet and downregulated Foxp3 and induced the shrift of immune balance which is critical in enhancing antitumor efficacy of QXC. Conclusions: QXC may have a therapeutic potential for patients with advanced colorectal cancer and deserved further investigation. Funding: This study was funded by National Natural Science Foundation of China (No. 81373824). (4101) Impact of Back Pain on Mortality Differs by Gender: Results of a Systematic Review and Meta-analysis Peter Stein, DC, PhD1, Lisa Fredman, PhD2, Howard Fink, MD, MPH3, Michael LaValley, PhD2, Eric Roseen, DC4, Robert B Saper, MD, MPH4 and Iniya Rajendran, MD4 1Boston University, Boston, Massachusetts 2Boston University School of Public Health, Boston, Massachusetts 3Minneapolis, Minnesota 4Boston, Massachusetts Abstract Purpose: Back pain is the most common cause of disability worldwide. While disability is associated with early mortality, the association between back pain and mortality is unclear. Individual studies may be limited by small sample sizes; therefore, we conducted a meta-analysis of published studies of back pain and mortality. Results: Fourteen studies were included in our primary meta-analysis. Among 87,937 total participants, adults with back pain had an increased risk of mortality in both random effect (RE) models (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.02–1.24 [I2 = 84%]) and fixed effect models (OR: 1.16, 95%CI: 1.13–1.20). Sex-stratified estimates show elevated mortality risk in women (RE OR: 1.37, 95%CI: 1.07–1.76) but not men (RE OR: 1.00, 95%CI: 0.76–1.15). The risk of mortality associated with back pain did not appear to increase with age (slope per year of mean study age = .005, P = .34). Conclusions: Among women, but not men, back pain was associated with a modest increase in risk of mortality. This study raises the question of whether better management of back related pain and disability, over time, may extend life. Future studies should evaluate the impact of longitudinal integrative medicine use on survival in adults with chronic back pain, especially for women. (4102) Echinacea purpurea: Deciphering the Controversy Behind Its Medicinal Properties Johanne A Gerstel, ND Student1 and Jeffrey O Langland, PhD2 1Tempe, Arizona 2Southwest College of Naturopathic Medicine, Tempe, Arizona Abstract Purpose: Rhinovirus infections are associated with the common cold. Symptomology and complications of rhinovirus infections are often linked to the immune response and the expression of the cytokine, IL-8. Rhinovirus complications may include chronic bronchitis, sinusitis, otitis media and asthma. Echinacea purpurea has historically been asserted as a therapy for rhinovirus infections, but results from clinical studies have been controversial. Many studies conclude that Echinacea is an effective therapeutic against the rhinovirus infections, whereas an equal number of reports claim the opposite. The purpose of our study was to investigate the biological activities of Echinacea based on different plant parts and various extraction methods. Results: Results demonstrated a dramatic difference between the root and flower portions of the plant, where flower ethanol extracts enhanced immune cytokine production, while ethanol extracts of the root repressed cytokine production and inhibited viral growth. In addition, a water extract of the root led to an enhancement in rhinovirus replication. Conclusions: Based on our results, predictions can be made where Echinacea flower extracted in ethanol or root extracted in water may lead to increased symptoms if used to treat a rhinovirus infection, while root extracted in ethanol would likely decrease and improve symptoms if used to treat a rhinovirus infection. From this, we can begin to understand and decipher the controversy surrounding the therapeutic efficacy of Echinacea where different plant parts and extraction methods will likely produce significantly different physiological responses. (4103) Acupuncture Versus Usual Care in the Abbott Northwestern Emergency Department: A Feasibility Randomized Trial Whitney L Wunderlich, MA1, Adam Reinstein, MAOM LAc1, Kristen H Griffin, MA, MPH1, Rachael L Rivard, MPH1, Michael Finch, PhD2, Chris E Kapsner, MD3 and Jeffery A Dusek, PhD3 1Minneapolis, Minnesota 2Children's Minnesota, Minneapolis, Minnesota 3Stckbridge, Massachusetts Abstract Purpose: Our prior observational research demonstrated that acupuncture was acceptable to patients and clinical providers in the Abbott Northwestern Emergency Department (ANW ED). We now evaluate the feasibility of conducting a randomized controlled trial (RCT) of acupuncture versus usual care in the ANW ED prior to a future multi-site RCT across the BraveNet Practice-Based Research Network (PBRN). Results: During the 8-month study period, 418 patients were screened for study eligibility: including but not limited to pain ≥4. Following screening, 59 were determined eligible, and 46 consented and were randomized to the study arms (23 to acupuncture, 23 to usual care). Those randomized to acupuncture reported a pre-treatment score of 8.18 (SD 1.62), a 60-min post-treatment decrease of 3.0 units (SD 2.51) and a decrease at ED discharge of 2.71 units (SD 1.86). Those randomized to usual care reported a pre-treatment score of 7.91 (SD 1.41), a 60-min post-treatment decrease of 1.56 units (SD 2.37) and a decrease at ED discharge of 2.53 units (SD 2.27). Since the aim of the RCT was feasibility of enrollment/retention and refinement of study procedures, between-group analyses were not appropriate nor conducted. Conclusions: Results from this feasibility RCT indicate successful enrollment/retention and that conduct of the RCT was acceptable to patient flow within the ANW ED. The success of this feasibility RCT indicates that a future multi-site RCT across the BraveNet PBRN is both achievable and warranted. (4105) Qualitative Evaluation of a Residential Yoga-Based Program for Frontline Professionals Tegan Reeves, MS1, Mindy Miraglia, MS2, Jeff A Dusek, PhD2, Lisa A Conboy, ScD3, Edi Pasalis, MBA4, Sat Bir S Khalsa, PhD4 and Natalie L Trent, PhD4 1University of Memphis, Memphis, Tennessee 2Kripalu Center for Yoga & Health, Stockbridge, Massachusetts 3Boston, Massachusetts 4Brigham and Women's Hospital, Boston, Massachusetts Abstract Purpose: The present study was a qualitative evaluation of Kripalu Center for Yoga & Health’s 5-day residential yoga-based program, called RISE (resilience, integration, self-awareness, engagement), for frontline professionals. The quantitative evaluation of the RISE program for psychological health and healthy behaviors has been published elsewhere. Results: Qualitative analyses using grounded theory revealed 5 major themes, related to improvements in psychological health and workplace dynamics: (1) increased resilience, particularly related to decreased levels of stress, (2) increased self-compassion and self-care, (3) experiential mindfulness, (4) continued use of inner resources/tools, such as breathing exercises, and (5) the advantages of a multiplier effect, which is defined as sharing the practices with colleagues and clients. Conclusions: The frontline professional participants of the RISE program described continued use of yoga-based concepts, skills, and practices that influenced their improvements in psychological health and well-being. Furthermore, participants reported sharing the practices with others as a means to multiply the impact and potentially reinforce their own practice. Future research will explore factors that facilitated the RISE participants to use of these practices beyond the RISE training. (4106) The Pain Management Inventory: Patterns of Conventional and Complementary Non-pharmacological Therapy Use in Minnesota National Guard Veterans Melvin Donaldson, MS1, Elizabeth S Goldsmith, MD, MS2, Lynsey R Miron, PhD, MA3, Erin E Krebs, MD, MPH4, Melissa A Polusny, PhD3 and Rich F MacLehose, PhD5 1Minneapolis, Minnesota 2Epidemiology, University of Minnesota, Minneapolis, Minnesota 3Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota 4Department of Medicine, University of Minnesota, Minneapolis, Minnesota 5Minneapolis, Minnesota Abstract Purpose: There is a growing body of research regarding complementary and integrative health approaches (CIH) in pain management, but the heterogeneity of techniques included in prior studies challenges the external validity of findings. We therefore developed and piloted the Pain Management Inventory (PMI)—a checklist of 20 common conventional and complementary non-pharmacological health approaches. The long-term goal of the present study is to facilitate standardized reporting of non-pharmacologic pain management in research. Results: Among all respondents, 74% endorsed use of any PMI approach, 43% any practitioner-delivered CIH (P-CIH), 26% any active/self CIH (A-CIH), and 15% both P-CIH and A-CIH (A&P-CIH). Forty-one percent reported chronic pain. The best fit model had 6 classes: low PMI use (51% of respondents; class mean different CIH modalities endorsed = 0.4), exercise users (23%; 1.1), psychotherapy users (5%; 2.2), multi-modal P-CIH users (12%; 2.6), multi-modal A-CIH users (6%; 3.2), and high-use mixed A&P-CIH (5%; 5.4). Conclusions: These findings suggest the existence of 6 subgroups of veterans characterized by their use of mixing multiple non-pharmacological health approaches. Over one-fourth of respondents reported using multiple CIH modalities over the previous year. We will discuss implications for patients with chronic pain. Future studies will examine the generalizability of the latent classes identified with the PMI in other patient populations. (4107) Chronic Epistaxis Successfully Treated by an Alternative Health Approach – A Case Report Yumin Cho, PhD1 and Ming-Dong Li, MD, PhD, LAc1 1Los Angeles, California Abstract Purpose: To address the alternative treatment for chronic epistaxis by using herbal medicine, acupuncture and a self-care plan. Results: The symptom of epistaxis was improved after the herbal treatment, with only one 5-min bleeding episode occurring the first month of treatment. This recurrence of his epistaxis was during his vacation when he forgot to take his herbal treatment for 3 days. The patient has had no nosebleed and any issues after restarting the continuous use of the herbal capsules. No bleeding episodes have been observed during a follow-up investigation over 8 months. Conclusions: The alternative health approach including herbal medicine and acupuncture combined with a self-care plan may be the effective treatment in chronic epistaxis. (4108) Patient Safety Surveillance on CAM Therapies: Challenges and Priorities Ram Vempati, PhD1 1Yoga Sangeeta, Sunnyvale, California Abstract Purpose: The patient safety of complementary and alternative medicine (CAM) is a primary concern of the public because CAM-Drug interactions often overlooked. However, patient safety surveillance activities largely have been focused on conventional medicines, and the current models of pharmacovigilance and its science and processes have developed in relation to pharmaceutical synthetic drugs. Applying the existing pharmacovigilance models and its tools from pharmaceutical industries to monitor the patient safety of herbal medicines, Ayurvedic preparations, other CAM therapies practiced in vulnerable patient population such as cancer patients, child and elderly population presents unique challenges in addition to those described for conventional medicines, and it is important that all stakeholders understand these. There is an increasing awareness at several levels of the need to develop pharmacovigilance practices for herbal medicines, including Ayurvedic medicines. Awareness has arisen not only because of the extensive use of herbal medicines, including Ayurveda, but also because in recent years there have been several high-profile herbal safety concerns, which have had an impact on public health. Research into the safety of CAM therapies presents challenges. Per WHO Traditional Medicine Strategy 2014–2023, it is clear from the global review that there are many opportunities and challenges in relation to national policies, law and regulation, quality, safety, and effectiveness of CAM therapies. The described risks associated with CAM products/therapies, practitioners, and self-care are mainly, use of poor quality, adulterated or counterfeit products; Unqualified practitioners; Misdiagnosis, delayed diagnosis, or failure to use effective conventional treatments; Exposure to misleading or unreliable information; Direct adverse events, side effects or unwanted treatment interactions. It is highly pertinent to promote the safety and quality of CAM by expanding the knowledge base, and providing guidance on regulatory and quality assurance standards notably by assessment of products and services, qualification of practitioners, methodology and criteria for evaluating efficacy. Based on available literature and CAM policy decision makers, problems in implementing CAM patient safety surveillance must be addressed which include: the apparently low incidence of harmful incidents or CAM practitioners ignoring the serious adverse events; the limited regulatory setting for CAM practice including the omission of CAM interventions from most mainstream adverse event reporting schemes; the widespread perception of CAM as natural and safe; the complexity of CAM therapies; interactions between CAM and Pharmaceutical drugs; professional self-satisfaction; and the special challenges unique to specific CAM therapies such as the concept of a “healing crisis.” Conclusions: The CAM researchers reached a consensus that the priority for CAM safety research is active surveillance, or the measurement of actual harm from CAM. The second priority is research into beliefs and attitudes of practitioners, public and professional organizations, and what influences those attitudes; the final research area covers the procedures used to ensure safe practice, and their effectiveness. (4109) Level of Evidence and Quality of Reports of Cranial and Visceral Osteopathic Treatment Trials Chantal Morin, PhD1 and Isabelle Gaboury, PhD1 1Universite de Sherbrooke, Longueuil, Quebec, Canada Abstract Purpose: Over the last 40 years, empirical osteopathy-related trial publications have doubled almost every 5 years. Trials on cranial and visceral osteopathic treatments represent more than one-third of this scientific output. The objectives of this project were (1) to assess the quality of reports of studies on cranial and visceral osteopathic treatment identified through a systematic review of all osteopathy-related trial publications, (2) to determine the level of evidence of these treatments by health problems, and (3) to identify criteria for which the quality of reports remains to be improved. Results: 106 and 51 studies were examined reporting respectively on cranial and visceral osteopathic treatment. Level of evidence was judged high (meta-analysis or randomized controlled trial) for 44 of the 72 health problems for which an osteopathic treatment was used. 38% and 25% of the cranial and visceral treatment trials, respectively, scored high in terms of quality of reports. Areas for improvement included reporting on sociodemographic characteristics of the participants, differences between groups prior to the intervention (for the non-randomized controlled trial studies), blinding, and adverse events. Conclusions: Less than one third of the trials retrieved presented a high quality of reporting. Although this is similar what was found for conventional medicine and other complementary medicine therapies, this study shows that efforts are needed to further increase the quality of reports in the osteopathy field. It also identifies health problems for which more rigorous studies are still required. (4110) An Integrative Clinical Initiative to Treat Patients Diagnosed With Microvascular Coronary Dysfunction Grant Antoine, ND1, Arvin Jenab, ND1 and Shaista Malik, MD, PhD, MPH1 1Susan Samueli Center for Integrative Medicine, Costa Mesa, California Abstract Purpose: Microvascular coronary dysfunction (MCD) is a multifactorial disorder that has become increasingly recognized as a cause of ischemia and angina associated with non-obstructive coronary disease. To date, there are no specific guidelines for the assessment or treatment of MCD, underlining the need for development of MCD focused clinical programs. This position paper aims to explore evidence-based strategies for the management of MCD, and to propose clinical initiatives from which to base multi-center collaboration for future study. Results: Current understanding implicates endothelial dysfunction (ED) as the primary mechanism by which blood flow is restricted. As a result of ED, the microvasculature of the heart becomes damaged and less compliant, resulting in inefficient exchange of gases and metabolites. Preliminary literature review also draws strong correlations between autonomic dysregulation, hormone deficiencies, and impaired cardiomyocyte metabolism in the development and progression of MCD. Current treatment options for MCD rely heavily on standard management of CAD ischemic disease and include pharmacotherapy with anti-hypertensives, anti-anginals, and statins. Conclusions: An integrative treatment approach that includes lifestyle modification, phytotherapy, nutraceutical supplementation, pharmacologic treatment, hormone replacement therapy, mind/body therapies, and cardiac rehabilitation could potentially reduce risk, improve quality of life, and decrease morbidity and mortality associated with MCD. (4111) Military Health Literacy Leadership Theory Angela McConnell, PhD1 1Woodbridge, Virginia Abstract Purpose: To educate on a new concept in successful intraprofessional integration of military/veteran collaboration. I offer the Military Health Literacy Leadership Theory (MHLLT) to promote productive effective communication, collaboration, and coordination between health officials, civilian healthcare providers, and military/Veterans leaders and Veteran population. The MHLLT incorporates and synthesizes systems and social network theory; collaborative leadership theory; value-based leadership theory; and the Be, Know, Do Military leadership model. It advances knowledge, abilities, and practical implementation methods for effective partnering and work with military leadership and effective communication and outreach to support the continuum of comprehensive health care for the Veteran/family civilian population. Integrative health leadership from a systems perspective does a comprehensive job of collaborating, coordinating, communicating, and partnering among actors and stakeholders from the multiple levels of government and throughout the community. This includes federal, state, and local government agencies, healthcare providers, urgent and emergency responders, and the general population. However, gaps are found around who, how, and when to work with military leaders. Additionally, there is no information on how and when to target the Veteran/family civilian population to provide public health care and support. Health literacy is the ability to obtain, read, understand, and use healthcare information to make appropriate healthcare decisions. Health officials may not be aware of their local community Veteran and family health needs, or if they are aware how best to target this population to provide necessary effective outreach, support, and services. A fundamental part of improving this gap in service and situation involves how public health leaders work with local military/Veteran leadership and organizations. There may be resistance on both sides of this leadership equation due to lack of understanding each other’s culture, language, scope of work, missions, and rules of engagement to include knowing the current supportive federal, state and local policies and initiatives (Copeland & Sutherland, 2010; Kudler & Straits-Troster, n.d.; Kuehner, 2012; Muerer, Bonner, Rowe, Morris, & Zgabay, n.d.; Pew Research Social & Demographic Trends, 2011; Straits-Troster & Goodale, 2011). In today’s environment of fewer resources and funding, we need to develop and utilize community health partnerships that include public health, nonprofit/profit healthcare providers, Department of Defense (DoD) (eg, military installations and military treatment facilities), Veteran Health Administration (VHA), and local, state, and federal government agencies/programs as necessitated (Copeland & Sutherland, 2010; Kuehner, 2012; Muerer, Bonner, Rowe, Morris & Zgabay, n.d.; Straits-Troster & Goodale, 2011). These partnerships allow the ability to be creative, innovative, and resourceful through leveraging each other’s expertise and resources in order to meet the joint specific mission of caring for our Veteran population. Creating and leveraging partnerships and joint programs are necessary due to the increasing number of Veterans reintegrating into the civilian population and their associated challenges and health conditions that can negatively impact themselves, their families, jobs, community, and overall quality of life (Berglass & Harrell, 2012; Chretien & Chretien, 2013; Coalition of Human Services Public Health District, 2014; Copeland & Sutherland, 2010; Deloitte Consulting, 2014; Department of Veteran Services, n.d; Institute of Medicine. 2013; Institute for Policy & Governance & Dunkenberger, 2010; Kemp & Bossarte, 2012; Muerer, Bonner, Rowe, Morris & Zgabay, n.d; Pew Research Social & Demographic Trends, 2011; Sayer, Noorbaloochi, Frazier, Carlson, Gravely & Murdoch, 2010; Straits-Troster & Goodale, 2011; White House, 2011). It is essential for healthcare leaders to know how, who, and when to work with military/Veteran organization leaders and how and when to provide public health and other healthcare/urgent care support to their Veteran/family population as part of their comprehensive systems approach to public health. To support these abilities and skills, they need to understand the culture, language, and best practices of the military. I propose a Military Health Literacy Model of Leadership that includes educating, exercising, and outreach tools and programs for public health leaders that will achieve two main objectives (Keian Weld, Padden, Ricciardi & Garmon Bibb, 2009). First, it will give public health leaders the ability to learn and understand military language, culture, and DoD/VHA best practices and resources in order to work with military/Veteran leaders from a shared vantage point thus providing them common ground. Second, it will give public health leaders the information and tools necessary for effective outreach and communication with their Veteran/family population in order to provide the necessary support and services. I propose a new public health leadership theory that promotes the ability to obtain, read, and understand military culture, language, and best practices to better collaborate, communicate, and coordinate with military leadership, and further the ability to effectively communicate and provide outreach and services for the Veteran/family population. Results: Outcomes include (1) greater understanding of the military and veteran tenants that are required for effective, efficient communications between military/veteran health/medicine/emergency response sectors and it's civilian counterparts and collaborators, (2) to actively engage leadership to include this education and practice within their areas of public health and integrative health leadership, and (3) to initiate and inspire action steps to incorporate Military Health Literacy into community/regional strategic planning in collaboration with military and government facilities/counterparts. Conclusions: The Military Health Literacy Leadership Theory and Model will fill a gap in public health leaders’ ability to effectively outreach to the Veteran population in order to meet specific and general needs, and efficiently work with military leadership on any joint civilian/military partnership and program. A fundamental part in closing this gap involves creating a supportive environment and common ground from which public health and the military/Veterans can operate. An environment that promotes mutual knowledge and understanding of culture, language, scope of work, missions, and rules of engagement to include knowing the current supportive federal, state, and local policies and initiatives. With fewer resources and increased missions and mandates, we need to have the flexibility and options to develop and utilize community health partnerships between public health, nonprofit/profit healthcare providers, Department of Defense, Veteran Health Administration and local, state, and federal government agencies/programs. It is essential for public health and integrative health leaders to know how, who, and when to work with military/Veteran organization leaders and how and when to provide public health support to their Veteran/family population as part of their comprehensive systems approach to public health. To support these abilities and skills, they should have the requisite knowledge of military culture, language, and best practices of the military. The Military Health Literacy Model of Leadership supports this through achieving two main objectives. First, it will give public health leaders the ability to learn and understand military culture, language, and DoD/VHA best practices and resources in order to work with military/Veteran leaders from shared vantage point thus giving them common ground. Second, it will give public health leaders the information and tools necessary for effective outreach and communication with their Veteran/family population in order to provide the necessary support and services. Note: References are available on request. (4112) Effect of Chamomile (Matricaria recutita) Syrup on Chemotherapy-Induced Neutropenia: A Randomized Triple-Blind Placebo Controlled Clinical Trial Majid Nimrouzi, MD, MPH, PhD1, Mehdi Shahriari, MD1 and Babak Daneshfard, MD, PhDc 1Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran Abstract Purpose: Acute lymphoblastic leukemia (ALL) is the most common malignancy of childhood. Chemotherapy-induced neutropenia as a serious hematologic toxicity is one of the main treatment complications in these patients. We hypothesized that an herbal formulation of chamomile could be effective in management of neutropenia. Results: A total number of 20 patients in each group (40 in total) finished the study. Comparison of longitudinal changes between the groups revealed higher level of WBC (P-value = .008) and absolute neutrophil count (P-value = .038) in the test group. In addition, patients in chamomile group had shorter course of hospitalization in comparison to control group (2 days on average). No adverse effect was reported. Conclusions: Using chamomile syrup as a complementary treatment in pediatric oncology patients can improve their immunity and minimize their chemotherapy complications, specially neutropenia. (4113) Medical Humanities in the Medical School Curriculum Kimberly Pham, BA1 and Robert Hage, MD, PhD1 1St George's University, St George's, Grenada Abstract Purpose: The care of the sick unfolds in stories. The effective practice of health care requires the ability to recognize, absorb, interpret, and act on the stories and plights of others. —Columbia University Narrative Medicine, webpage St George’s University (SGU) graduates undertake residencies in human and veterinary medicine across the United States, Canada, Great Britain, and beyond. Recognizing the potential for an integrative medicine approach to improve patient and population health locally and globally, SGU incorporates integrative medicine into aspects of its human and veterinary medical curricula, both formally and informally. The successes of integrative medicine in improving health are documented in, among others, stories that capture the lived experiences of those involved in illness and its management. Medical humanities is one means of understanding and sharing those stories. Medical humanities move beyond objective scientific knowledge and expose students and clinicians to emotional and other subjective responses to health, illness, and healthcare. In doing so, medical humanities can improve patient care, patient satisfaction, and physician job satisfaction by bringing reflection and meaning to challenging experiences in the healthcare arena. We use the lens of integrative medicine to examine how medical humanities offer SGU medical and veterinary students a space to hone observational, reflective, and narrative skills as they move towards their clinical training and practice. SGU’s School of Medicine (SOM) offers medical humanities courses at some of its hospitals. Additionally, ad hoc activities through an Integrative Medicine Selective offered to Basic Sciences students exposes students to opportunities to reflect on the value of medical humanities to their future practice. We outline some of these activities and reflect on how these may enhance the future and practice of integrative medicine. (4114) Yoga Therapy and Integrative Medicine: Oncology Perspective Chidananda Murthy, BT, ND, DY, DPPHC, PhD, YO1 and Ram Vempati, PhD2 1Wellness Center, Monticello, Sullivan County, New York 2Yoga Sangeeta, Sunnyvale, California Abstract Purpose: Yoga is one of the fastest growing health and wellness sooqs in the world. Within this field, a specialized therapeutic discipline known as Yoga Therapy has emerged. In this complementary treatment approach, the specialized practice of yoga is applied towards relieving and healing specific disease conditions. With its remarkable results, this revolutionary approach to an ancient practice is rapidly gaining tremendous respect among medical doctors and health care professionals. Several clinical studies have shown that yoga can be integrated with modern medicine for many disease conditions including some oncological conditions. This integrated medical approach using yoga as an adjuvant therapy, as applied in some oncology conditions, has been shown to help patients at both early and advanced stages of the cancer experience to minimize their pain and fatigue while increasing their psychological strength to fight cancer, overcome denial, and for relaxation. Ethical dilemmas arising in setting priorities among interventions and among individuals in need of care are most acute when needs are great and resources few. Under ethical considerations, yoga cannot be introduced as a stand-alone treatment for cancer conditions. Hence, it can only be applied as an adjuvant treatment along with an established medical regimen. However, some of earlier clinical studies lacked in proper clinical study protocols as per ICH guidelines in terms of collecting quality of data and efficacy and safety measures. Conclusions: It is the need of the hour to discuss role of yoga in the realm of integrative medicine especially from an oncology perspective. Furthermore, while designing clinical trials as well as yoga treatment protocols, it is highly recommended to follow ICH guidelines for collecting efficacy and safety clinical data.