Reporting quality of music intervention research in healthcare: A systematic review

INTRODUCTION: Concomitant with the growth of music intervention research, are concerns about inadequate intervention reporting and inconsistent terminology, which limits validity, replicability, and clinical application of findings. OBJECTIVE: Examine reporting quality of music intervention research, in chronic and acute medical settings, using the Checklist for Reporting Music-based Interventions. In addition, describe patient populations and primary outcomes, intervention content and corresponding interventionist qualifications, and terminology. METHODS: Searching MEDLINE, PubMed, CINAHL, HealthSTAR, and PsycINFO we identified articles meeting inclusion/exclusion criteria for a five-year period (2010-2015) and extracted relevant data. Coded material included reporting quality across seven areas (theory, content, delivery schedule, interventionist qualifications, treatment fidelity, setting, unit of delivery), author/journal information, patient population/outcomes, and terminology. RESULTS: Of 860 articles, 187 met review criteria (128 experimental; 59 quasi-experimental), with 121 publishing journals, and authors from 31 countries. Overall reporting quality was poor with <50% providing information for four of the seven checklist components (theory, interventionist qualifications, treatment fidelity, setting). Intervention content reporting was also poor with <50% providing information about the music used, decibel levels/volume controls, or materials. Credentialed music therapists and registered nurses delivered most interventions, with clear differences in content and delivery. Terminology was varied and inconsistent. CONCLUSIONS: Problems with reporting quality impedes meaningful interpretation and cross-study comparisons. Inconsistent and misapplied terminology also create barriers to interprofessional communication and translation of findings to patient care. Improved reporting quality and creation of shared language will advance scientific rigor and clinical relevance of music intervention research

Guide for third and fourth year students

Advice compiled by Boston University School of Medicine students for incoming first year students and third or fourth year students preparing for clinical rotations

Using Informatics to Improve Autism Screening in a Pediatric Primary Care Practice

Background: According to the most recent report from the CDC (2018), autism spectrum disorder (ASD) affects approximately one in 59 children in the United States (U.S.). In 2007, the American Academy of Pediatrics (AAP) issued a strong recommendation for all primary care providers to screen children for autism, using a validated tool, at the 18 and 24-month well-child visits, in order to begin the referral process for more formal testing, and intervention, promptly. Despite the strong stance of the AAP and evidence supporting the importance of early intervention for children with ASD, not all primary care providers are screening for ASD or developmental delay. Purpose: To improve the percentage of eligible children, presenting for 18 and 24 month wellchild visits in a pediatric primary care office, who are screened for ASD, by integrating the Modified Checklist for Autism in Toddlers (M-CHAT) screening tool into the electronic medical record with tablets. The specific aims were to increase the percentage of children screened and improve the documentation of the screens performed. Methods: This quality improvement project utilized a before-after quantitative design to support the improvement. Reports were obtained for three months prior to the implementation of the tablets and process change, and again for three months following the implementation. Manual chart reviews were also performed to verify the data from the reports. The definition used for complete screening for this project included 1) presence of the completed screen in the medical record, 2) provider documentation of the result, interpretation, and plan if indicated, and 3) CPT code entry for charge capture completed in the electronic medical record. Results: The results of the project revealed improvements in overall percentages of eligible children screened for autism at D-H Nashua Pediatrics. The percentage of complete screening increased from 64.7% to 73.9% following the implementation of the project, a change which is statistically significant (t=31.6105, df=16,p=0.05). Each individual element was also tracked and those results showed that 1) the completeness of provider documentation related to the screening increased from 93.6% to 96% (t=41.3321, df=16, p=0.05) and 2) the M-CHAT screen was present in the electronic health record (EHR) 98.9% of the time, which was an increase from 84.6% (t=295.4084, df=16, p=0.05). The charge capture completion rate remained statistically unchanged at 76.5% (t=0.4664, df=16, p=0.05). Additionally, only one screening was noted to be missed altogether, out of 280 eligible children. Prior to the project, there were four missed screenings (out of 156 eligible children) captured by the chart reviews conducted over three months prior to the implementation of the project. Overall, the results show that the project resulted in an increase the percentage of M-CHAT screening, an increase in the presence of source documentation in the electronic health record (EHR), and more complete provider documentation related to the screening

Description and Experience of the Clinical Testbeds

This deliverable describes the up-to-date technical environment at three clinical testbed demonstrator sites of the 6WINIT Project, including the adapted clinical applications, project components and network transition technologies in use at these sites after 18 months of the Project. It also provides an interim description of early experiences with deployment and usage of these applications, components and technologies, and their clinical service impact

Exploration, design and application of simulation based technology in interventional cardiology

Medical education is undergoing a vast change from the traditional apprenticeship model to technology driven delivery of training to meet the demands of the new generation of doctors. With the reduction in the training hours of junior doctors, technology driven education can compensate for the time deficit in training. Each new technology arrives on a wave of great expectations; sometimes our expectations of true change are met and sometimes the new technology remains as a passing fashion only. The aim of the thesis is to explore, design and apply simulation based applications in interventional cardiology for educating the doctors and the public. Chapters 1and 2 present an overview of the current practice of education delivery and the evidence concerning simulation based education in interventional cardiology. Introduction of any new technology into an established system is often met with resistance. Hence Chapters 3 and 4 explore the attitudes and perceptions of consultants and trainees in cardiology towards the integration of a simulation based education into the cardiology curriculum. Chapters 5 and 6 present the “i-health project,” introduction of an electronic form for clinical information transfer from the ambulance crew to the hospital, enactment of case scenarios of myocardial infarction of varied levels of difficulty in a simulated environment and preliminary evaluation of the simulation. Chapter 7 focuses on educating the public in cardiovascular diseases and in coronary interventional procedures through simulation technology. Finally, Chapter 8 presents an overview of my findings, limitations and the future research that needs to be conducted which will enable the successful adoption of simulation based education into the cardiology curriculum.Open Acces

Guide for third and fourth year students

Advice complied by Boston University School of Medicine students for incoming first year students and third or fourth year students preparing for clinical rotations

Progress Notes

https://scholarlyworks.lvhn.org/progress_notes/1298/thumbnail.jp

Telemedicine Training in Undergraduate Medical Education: Mixed-Methods Review.

BACKGROUND: Telemedicine has grown exponentially in the United States over the past few decades, and contemporary trends in the health care environment are serving to fuel this growth into the future. Therefore, medical schools are learning to incorporate telemedicine competencies into the undergraduate medical education of future physicians so that they can more effectively leverage telemedicine technologies for improving the quality of care, increasing patient access, and reducing health care expense. This review articulates the efforts of allopathic-degree-granting medical schools in the United States to characterize and systematize the learnings that have been generated thus far in the domain of telemedicine training in undergraduate medical education. OBJECTIVE: The aim of this review was to collect and outline the current experiences and learnings that have been generated as medical schools have sought to implement telemedicine capacity-building into undergraduate medical education. METHODS: We performed a mixed-methods review, starting with a literature review via Scopus, tracking with Excel, and an email outreach effort utilizing telemedicine curriculum data gathered by the Liaison Committee on Medical Education. This outreach included 70 institutions and yielded 7 interviews, 4 peer-reviewed research papers, 6 online documents, and 3 completed survey responses. RESULTS: There is an emerging, rich international body of learning being generated in the field of telemedicine training in undergraduate medical education. The integration of telemedicine-based lessons, ethics case-studies, clinical rotations, and even teleassessments are being found to offer great value for medical schools and their students. Most medical students find such training to be a valuable component of their preclinical and clinical education for a variety of reasons, which include fostering greater familiarity with telemedicine and increased comfort with applying telemedical approaches in their future careers. CONCLUSIONS: These competencies are increasingly important in tackling the challenges facing health care in the 21st century, and further implementation of telemedicine curricula into undergraduate medical education is highly merited

Implementation of a Surgical Safety Checklist

Lack of standardization in the perioperative area leads to variations in practice that can cause preventable errors. In a 200-bed hospital in Northern California with eleven operating rooms preforming approximately 11,000 procedures a year, there was an increase incidence in sentinel events such as wrong site surgery (n=1), wrong patient surgery (n=1), and retained foreign body (n=5). Safety checks observed in the operating room (OR) were preformed differently among each surgical team and sometimes did not occur at all. Through the use of a Surgical Safety Checklist (SSC), efforts were aimed to standardize safety practices in the OR. The goal was to ensure 90% adherence to the requirements on the SSC based on observational assessment of the process within four months of implementation. Weekly observational audits were conducted over a four-month period to examine the adherence to each checklist component. The mean overall compliance increased in all three phases: Sign In (63% to 70%), Time Out (60% to 73%,) and Sign Out (85% to 100%). Seventeen good catches were identified in Patient Safety Reports that were identified in the following phases: Sign In (n=2), Time Out (n=9), and Sign Out (n=6) phase. The use of the Surgical Safety Checklist encouraged a standardized approach to enhance multidisciplinary teamwork and communication by ensuring the completion of critical tasks which lead to early recognition of “near misses”

Guide for third and fourth year students

Advice complied by Boston University School of Medicine students for incoming first year students and third or fourth year students preparing for clinical rotations