Objective: To evaluate a Produce Prescription Programme’s utilisation, and its effects on healthy food purchasing and diabetes control among participants with type 2 diabetes. Design: Prospective cohort study using participants’ electronic health records (EHR) and food transaction data. Participants were categorized as “Frequent Spenders” and “Sometimes Spenders” based on utilisation frequency. Multivariate regressions assessed utilisation predictors; and programme effects on fruit/vegetable purchasing (spending, expenditure share, variety) and on diabetes-related outcomes (HbA1c, BMI, blood pressure). Setting: Patients enrolled by clinics in Durham, North Carolina, USA. Participants received $40 monthly for fruits and vegetables at a grocery store chain. Subjects: 699 food-insecure participants (353 with diabetes). Results: Being female and older was associated with higher programme utilisation; hospitalisations were negatively associated with programme utilisation. Frequent Spender status was associated with $8.77 more in fruit/vegetable spending (p < 0.001), 3.3% increase in expenditure share (p = 0.007), and variety increase of 2.52 fruits and vegetables (p < 0.001). For $10 of Produce Prescription Dollars spent, there was an $8.00 increase in fruit/vegetable spending (p < 0.001), 4.1% increase in expenditure share, and variety increase of 2.3 fruits/vegetables (p < 0.001). For the 353 participants with diabetes, there were no statistically significant relationships between programme utilisation and diabetes control. Conclusions: Programme utilisation was associated with healthier food purchasing, but the relatively short study period and modest intervention prevent making conclusions about health outcomes. Produce Prescription Programmes can increase healthy food purchasing among food-insecure people, which may improve chronic disease care.

PurposePain is multi-dimensional and may be better addressed through a holistic, biopsychosocial approach. Massage therapy is commonly practiced among patients seeking pain management; however, its efficacy is unclear. This systematic review and meta-analysis is the first to rigorously assess the quality of massage therapy research and evidence for its efficacy in treating pain, function-related and health-related quality of life in cancer populations.MethodsKey databases were searched from inception through February 2014. Eligible randomized controlled trials were assessed for methodological quality using the SIGN 50 Checklist. Meta-analysis was applied at the outcome level. A diverse steering committee interpreted the results to develop recommendations.ResultsTwelve high quality and four low quality studies were subsequently included in the review. Results demonstrate massage therapy is effective for treating pain compared to no treatment [standardized mean difference (SMD)  = −.20] and active (SMD = −0.55) comparators. Compared to active comparators, massage therapy was also found to be beneficial for treating fatigue (SMD = −1.06) and anxiety (SMD = −1.24).ConclusionBased on the evidence, weak recommendations are suggested for massage therapy, compared to an active comparator, for the treatment of pain, fatigue, and anxiety. No recommendations were suggested for massage therapy compared to no treatment or sham control based on the available literature to date. This review addresses massage therapy safety, research challenges, how to address identified research gaps, and necessary next steps for implementing massage therapy as a viable pain management option for cancer pain populations.

PurposePain is multi-dimensional and may be better addressed through a holistic, biopsychosocial approach. Massage therapy is commonly practiced among patients seeking pain management; however, its efficacy is unclear. This systematic review and meta-analysis is the first to rigorously assess the quality of massage therapy research and evidence for its efficacy in treating pain, function-related and health-related quality of life outcomes across all pain populations.MethodsKey databases were searched from inception through February 2014. Eligible randomized controlled trials were assessed for methodological quality using SIGN 50 Checklist. Meta-analysis was applied at the outcome level. A diverse steering committee interpreted the results to develop recommendations.ResultsSixty high quality and seven low quality studies were included in the review. Results demonstrate massage therapy effectively treats pain compared to sham [standardized mean difference (SMD) = −.44], no treatment (SMD = −1.14), and active (SMD = −0.26) comparators. Compared to active comparators, massage therapy was also beneficial for treating anxiety (SMD = −0.57) and health-related quality of life (SMD = 0.14).ConclusionBased on the evidence, massage therapy, compared to no treatment, should be strongly recommended as a pain management option. Massage therapy is weakly recommended for reducing pain, compared to other sham or active comparators, and improving mood and health-related quality of life, compared to other active comparators. Massage therapy safety, research challenges, how to address identified research gaps, and necessary next steps for implementing massage therapy as a viable pain management option are discussed.

resident Obama's Precision Medicine Initiative has refocused national attention on the ability of genomics and other emerging technologies to provide a better understanding of the relationship between genetics, environment, lifestyles, and the development of disease 1. This initiative was heralded as a "bold new research effort to revolutionize how to improve health and treat disease" 2. Yet, in 2000 the sequencing of the human genome was also anticipated to lead to new ways to personalize medicine and to prevent, diagnose, and cure disease. While there have been major advances in diagnosing and treating disease, the goals for personalized medicine to improve health and prevent disease have not yet been achieved 3-5. Despite the benefits of more targeted disease treatments, the real promise of personalized/precision medicine lies in its ability to prevent disease and improve health as, in addition to the human cost, our nation spends almost 80% of its unaffordable health care expenses on treating complex, chronic diseases which are preventable. Research in precision medicine will certainly provide new capabilities to improve health and minimize disease, but to actually do so, the approach to the practice of medicine must change so it is prepared to use them. The Limitations of Reductionism in Medicine Medical care today is derivative of concepts developed over a century ago when science began to be applied to the practice of medicine and identified the causes of many, particularly infectious, diseases. The logical assumption arose that diseases have a root cause and the role of the physician became to "find it and fix it." This concept led to a paradigm of care based on the capability of the physician to identify the disease underlying the patient's chief clinical complaint and, when possible, eliminate the cause. With improving technologies and clinical experience, this reductionist approach to care has improved and resulted in wondrous cures and treatments for many diseases. However, the concept of treating disease by removing its root cause is overly simplistic in dealing with the increasingly common chronic multifactorial diseases that develop over long periods of time. Complex chronic diseases such as obesity, type II diabetes, and cardiovascular disease are but a few examples of many conditions which account for a vast proportion of our nation's health and medical expenses. As medical practice continues to be reactive to the patient's chief complaint rather than also being proactive, care is not designed to effectively adopt new technologies to improve health or predict and prevent disease. To do this, a new approach to care is needed; one that utilizes the best of what works in the current system but is based on what we know about the evolution of disease.

The transition and transfer from pediatrics to adult health care of youth with and without special health care needs has become a focus of professional organizations, health care insurers, national policy makers, and providers. To understand transition and transfer at a primary care practice level, all primary care pediatricians in Rhode Island were surveyed. Responses were received from 103 of 169 (60.9%) practicing pediatricians. Few responders had practice policies on transfer. Most reported that transition should begin later than recommended. Few practices communicated with adult providers at transfer. Most reported that health insurers were of little help in transfer. Many pediatric practices had young adults after age 22 and many with special needs. Responders reported adolescents left their practices by 1 of 6 methods. The survey indicates the need for further study of transition and transfer and the need for additional training and education if transfers are to be successful.