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BACKGROUND: Randomized controlled trials show acupuncture and acupressure support anesthesia management by decreasing anxiety, opioid requirements and treating post-operative nausea and vomiting. Acupuncture and acupressure have demonstrated clinical usefulness and received governmental support (NIH, PPACA, WHO, U.S. Military), but have not yet diffused into mainstream anesthesia practice. This study examined US anesthesia providers' perceptions of acupuncture and acupressure. METHODS: Ninety-six anesthesiology departments stratified by geographic region (Northeast, South, West, and Midwest) and institution type (university medical centers, community hospitals, children’s hospitals, and VA hospitals) were selected for participation in an anonymous, online survey. The target sample was 1,728 providers of which N = 292 (54% anesthesiologists, 44% CRNAs, 2% AAs) responded yielding an overall 17% response rate. RESULTS: Spearman’s correlation coefficient revealed a statistically significant correlation between acupuncture and geographic region, with the West having the highest predisposition toward acupuncture use (rs = 0.159, p = 0.007). Females are more likely to use acupuncture than men (rs = -.188, p = 0.002). Age yielded a moderate effect size with providers between the ages of 31-50 years old experiencing the best outcomes administering acupuncture (rs = 0.65, 95% CI = 2.79, 3.06). A strong effect size exists between acupuncture and country of pre-anesthesia training (rs = 1.00, 95% CI = 1.08, 1.16). Some providers have used acupuncture (27%) and acupressure (18%) with positive outcomes, however the majority of providers have not used these modalities, but would consider using them (54%, SD = 1.44 acupuncture; 60%, SD = 1.32 acupressure). Seventy-six percent of respondents would like acupuncture education and 74% would like acupressure education (SD = 0.43, SD = 0.44, respectively). Lack of scientific evidence (79%, SD = 0.73) and unavailability of credentialed providers (71%, SD = 0.92) were the primary barriers. CONCLUSIONS: While most U.S. anesthesia providers have not used these modalities, they still report a favorable perception of acupuncture/acupressure’s role as part of an anesthetic and the majority of providers express an interest in receiving education. This study adds to the body of acupuncture and acupressure research by providing insight into anesthesia providers’ perceptions of these alternative medicine modalities.

Thesis advisor: Ted I. K. Youn / Independent professional schools were a significant part of higher education in the United States until the rise of universities at the beginning of the 20th century. In the 21st century, the overwhelming majority of professional schools are indeed affiliated with universities; however there are a growing number of professional schools in variety of fields that are independent. The institutional perspective from organizational theory suggests these schools, like all organizations, must be creating and maintaining legitimacy in order to survive. This multiple case study explores how independent professional schools of acupuncture and Oriental medicine (AOM) demonstrate legitimacy over time. Analysis was focused on temporal patterns, correlations, and interdependencies between and/or among particular legitimizing activities within institutions, and global patterns of legitimizing activities across different institutions. Data were analyzed with specific reference to the possibility that there are multiple alternative paths to legitimacy outside of isomorphism with educational myths and structures. Findings included identification of higher education, health care, context, the profession, and business as the five arenas in which AOM schools signal their legitimacy, as well as general patterns of signaling to these arenas across all institutions over the past twenty years. Signals in each arena ebb and flow between relatively narrow limits, and it is not possible for schools to increase their signals in all areas simultaneously. Over time, the business and academic signals are generally increasing, contextual and professional signals decreasing, and health care remains fairly stable. This research marks an initial effort bring scholarly awareness both to schools of acupuncture and Oriental medicine to independent professional schools as a group. It offers support for the idea that there are multiple avenues for demonstrating legitimacy, and suggests a model for the arenas in which legitimacy operates for independent professional schools. In addition, this research articulated the concept of multi-liminality as both a characteristic of independent professional schools and an important feature for future research. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Lynch School of Education. / Discipline: Educational Leadership and Higher Education.