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

The Evolving Pharmacotherapeutic Landscape for the Treatment of Sickle Cell Disease.

Sickle cell disease (SCD) is an extremely heterogeneous disease that has been associated with global morbidity and early mortality. More effective and inexpensive therapies are needed. During the last five years, the landscape of the pharmacotherapy of SCD has changed dramatically. Currently, 54 drugs have been used or under consideration to use for the treatment of SCD. These fall into 3 categories: the first category includes the four drugs (Hydroxyurea, L-Glutamine, Crizanlizumab tmca and Voxelotor) that have been approved by the United States Food and Drug Administration (FDA) based on successful clinical trials. The second category includes 22 drugs that failed, discontinued or terminated for now and the third category includes 28 drugs that are actively being considered for the treatment of SCD. Crizanlizumab and Voxelotor are included in the first and third categories because they have been used in more than one trial. New therapies targeting multiple pathways in the complex pathophysiology of SCD have been achieved or are under continued investigation. The emerging trend seems to be the use of multimodal drugs (i.e. drugs that have different mechanisms of action) to treat SCD similar to the use of multiple chemotherapeutic agents to treat cancer

Examination of Acute Care Nurses Ability to Engage in Patient Education Related to Physical Activity as a Health Behavior

Physical activity is important for management and prevention of chronic disease. The current physical activity guidelines recommend engaging in physical activity for at least 30 minutes per day on at least 5 days a week. Acute care settings may present opportunities for patient education about physical activity. PURPOSE: The purpose of this study was to examine the ability of acute care nurses to engage in patient education regarding physical activity as a health behavior. Additionally, this study examined the influence of level of nurse training, age, personal physical activity and years of experience on these outcomes. METHODS: Nurses from an academic medical center (N=194) were surveyed. Knowledge of current physical activity guidelines, rank of importance of physical activity as a patient care activity and a healthy lifestyle behavior, and confidence to counsel patients about physical activity were queried. RESULTS: Of nurses queried, 32.5% reported days per week and 83% reported minutes per day to engage in physical activity consistent with current guidelines. Physical activity counseling was ranked least important of ten patient care activities and fifth as a healthy lifestyle behavior. The majority of nurses (51%) felt some degree of confidence to counsel patients regarding physical activity. Baccalaureate level nurses were more likely to be consistent with physical activity guidelines than master’s level nurses. Nurses <25 years of age were more current in knowledge of physical activity guidelines than nurses ≥41 years of age. Nurses who exercised were more likely to report knowing current physical activity guidelines. Reported time spent counseling patientsregarding physical activity averaged 6 minutes per patient per day. CONCLUSION: Acute care nurses are counseling patients regarding physical activity although it is ranked least important of ten patient care activities. Future research should include studying: a variety of patient populations; other hospital settings; objective measures of evaluation; and nurses’ training regarding physical activity

Disparities In Socioeconomic Context And Response To Antihypertensive Medication In The Antihypertensive And Lipid-Lowering Treatment To Prevent Heart Attack Trial (allhat)

Where one lives affects one’s blood pressure. Observational studies demonstrate that living in communities of low socioeconomic status is associated with higher blood pressure and worse cardiovascular outcomes. In understanding the reasons for these disparities, a key question is whether evidence-based antihypertensive medication therapy is less effective in lowering blood pressure and improving cardiovascular outcomes in lower socioeconomic communities. If so, then anti-hypertensive therapies derived from randomized clinical trials (RCTs) may be suboptimal in achieving expected outcomes. Despite standardized protocols and balancing of demographic and clinical characteristics between study arms of RCTs, the socioeconomic environment in which people live is rarely examined, potentially exerting an unmeasured effect on study outcomes. To determine the impact of socioeconomic context on response to antihypertensive medication in clinical trials, we analyzed data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), the largest existing RCT of hypertension treatment. This trial, conducted from 1994 to 2002, randomized 42,418 people, 55 years or older, with hypertension and at least one other cardiovascular risk factor, to chlorthalidone, lisinopril, amlodipine or doxazosin (mean follow-up of 4.9 years). After excluding non-continental U.S. sites and the doxazosin arm (terminated early in ALLHAT) our study included 27,862 participants. We defined socioeconomic context by mapping study site ZIP codes to counties and stratifying these counties into income quintiles based on the national distribution of county median household income, adjusted for cost-of-living, from the 2000 U.S. census. We compared baseline and clinical characteristics, visit and medication adherence, blood pressure control, and cardiovascular outcomes between ALLHAT participants in the lowest and highest income sites using multivariable regression models. Participants receiving care in Quintile 1 (Q1, lowest income sites) (n = 2169, 7.8%) were more likely to be female, black, Hispanic, have fewer total years of education, live in the South, and have fewer cardiovascular risk factors than participants in Quintile 5 (Q5, highest income sites) (n = 10458, 37.6%). Compared with Q5, participants in Q1 were less likely to achieve blood pressure control (\u3c140/90 mmHg) (OR, 0.48; 95% CI, 0.37- 0.63), and experienced higher all-cause mortality (HR, 1.25; 95% CI, 1.10-1.41), heart failure hospitalizations or mortality (HR, 1.26; 95% CI, 1.03-1.55) and end-stage renal disease (ESRD) (HR, 1.86; 95% CI, 1.26-2.73), though lower angina hospitalizations (HR, 0.70; 95% CI, 0.59-0.83) and coronary revascularization (HR, 0.71; 95% CI, 0.57- 0.89). There were no differences in stroke, myocardial infarction, or peripheral arterial disease. Despite having access to standardized treatment protocols, participants in the lowest income sites experienced poorer blood pressure control, higher mortality, ESRD and heart failure morbidity, and decreased coronary revascularization compared to those in the highest income sites. These findings suggest a need to better measure and bolster the socioeconomic context beyond the medical environment to eliminate disparities in outcomes for RCTs of antihypertensive medications. Understanding these relationships may guide the generalizability of RCT findings, promote the assessment of participants’ socioeconomic context in clinical trials and hypertension treatment guidelines, and inform broader strategies for combating hypertension in populations living in low socioeconomic environments

Older adults’ activity on a geriatric hospital unit: A behavioral mapping study

Systematic reviews highlight a preponderance of prolonged sedentary behavior in the hospital setting, with possible consequences for patients’ health and mobility. To date, most of the published literature in this field focus on the hospital experience for older adults with dementia or stroke. Few data describe hospital activity patterns in specialized geriatric units for frail older adults, who are already at risk of spending prolonged periods of time sitting. Yet, promoting older adults’ activity throughout hospitalization, when possible, is an avenue for exploration to identify opportunities to encourage more daily functional activities, and minimize the risk of post-hospital syndrome. These exploratory findings are an opportunity to, generate hypotheses for future testing, and act as a starting point to collaborate with front line clinicians to highlight the indoor environment’s role in promoting activity, and develop future strategies to safely introduce more activity into the acute care setting for older adult

Experiences of hospitalized patients with dementia

People with dementia are hospitalized for a variety of reasons. The combination of dementia with additional health conditions creates a unique challenge to caregivers in acute care settings. There is a dearth of information available to provide guidance to the nursing staff caring for these patients. This integrated review of the literature examined the experiences of hospitalization from the perspective of the older adult with dementia, the family caregiver, and the patient care staff. Results showed a limited body of literature that addressed hospital experiences of people with dementia and those of family and professional caregivers. Additionally, few studies addressing this topic have been conducted in the United States. The primary finding from this study is that better communication is needed between nursing staff, patients, and their family caregivers. Nurses should carry out detailed assessments of cognition and pain in all elderly patients, and strive to provide appropriate palliative and end-of-life care. Dementia- specific training for all staff members may help to promote a better understanding of patients with dementia. Lastly, further research into the experiences of hospitalized dementia patients is needed, with a focus on acute care settings within the United States

Improving the quality of care for older adults:Towards person-centred integrated care supported by digital health technology

Healthy ageing is a global priority as people worldwide are living longer. With longer lifespans, older adults are at increased risk of chronic conditions. Service provision based on disease-specific guidelines can be inappropriate for people with multiple health conditions; care can become duplicative and inefficient due to poor coordination. Person-centred integrated care is seen as a promising approach to delivering care that is proactive, coordinated and centred around people’s needs. In addition, digital health technology has the potential to involve patients better in their care process and could, therefore, support person-centred integrated care. The aim of the research presented in this thesis was to improve the quality of care for older adults by studying person-centred integrated care supported by digital health technology

Stroke Symptom Identification Tool for Hospitalized Patients in a Rural Setting

Thousands of persons in the United States yearly suffer acute large vessel occlusion stroke (LVO). Caring for these individuals with strokes and the ensuing issues increases healthcare dollars. In underserved, rural communities, there is a dire need for improved methods to access care for these individuals. A 3-month evidence-based practice (EBP) project was conducted in a small rural town in Virginia with one of the state’s highest rates of acute stroke. Nurses in the rural hospital voluntarily participated in an educational program on recognizing acute stroke and utilizing the Vision, Aphasia, Neglect (VAN) assessment tool. The participants (N-15) were asked to complete pre- and post-questionnaires on stroke and VAN knowledge. In addition, the nurses completed a Likert confidence scale and a subjective evaluation at the end of the 12 weeks. Nurses were given a badge card and a smartphone application to help remind them of the VAN assessment. Following the educational program, the participants had a 7.5% increase in knowledge. After the 3-month intervention, the overall knowledge retention was only 1.7%, thus a 5.8 percent decrease in knowledge retention. According to the Likert scale and subjective data, the nurse’s comfort level with recognizing patients who could be suffering from an acute LVO stroke increased. The data confirms that educating the nursing staff is crucial in recognizing new acute stroke symptoms in their patient population. VAN assessment tools, badge cards, and smartphone applications are effective interventions that need frequent re-education and reinforcement of learning concepts to increase the recognition of acute LVO stroke symptoms in the patient population

Factors Influencing Nurses\u27 Intentions to Provide Weight Management Education to Hospitalized Obese Adults

Obesity is a sensitive, global health problem that impacts individuals of all ages and places individuals at risk for various chronic health problems. Nurses caring for hospitalized obese clients are in a prime position to provide them with timely information on weight management. This study utilized an exploratory sequential mixed method design to examine medical-surgical nurses\u27 intentions to provide weight management education to hospitalized obese adults and the factors that influence nurses\u27 intentions. In phase 1, a focus group interview guide and nurse demographic form (NDF) were developed. Focus groups were conducted and analysis resulted in the creation of 15 salient beliefs and 12 broad categories. In Phase 2, focus group results were used to construct the Weight Management Education Survey (WMES) guided by Azjen\u27s Theory of Planned Behavior (TPB) for question development. A total of 71 WMES items were developed based on the main TPB components: 24 attitude; 16 subjective norm; 26 perceived behavioral control; and 5 intention. The WMES was piloted with 12 RNs in the same setting; nurses also completed the NDF. In phase 3, the WMES with minor changes was electronically administered with the NDF to a national pool of 354 RNs who held membership in the Academy of Medical Surgical Nurses. Of the nurses who completed the WMES, 85.8% (n = 318) responded they would provide weight management education if clients asked for the information. A 12-factor solution explained 80% of the variation in response; seven of those factors explained 52% of the variation in the principle component of intention . Factors significant in predicting nurses\u27 intentions included: health benefits (p \u3c 0.0001), reducing costs and admissions (p \u3c .0001), client/family approval (p \u3c 0.0001), institutional approval (p \u3c 0.0001), home-based weight management plan on admission (p \u3c 0.0001), staffing and timing (p = 0.0055), and acute illness priority (p =0.0022). After removing variation explained by factors, demographics explained less than 5% variation in nurses\u27 intentions. Establishing a standardized collaborative approach for instituting a home-based weight management plan on admission may increase the likelihood that nurses will choose to provide weight management education for their clients

A critical evaluation of the use of interpretative phenomenological analysis (IPA) in health psychology

With the burgeoning use of qualitative methods in health research, criteria for judging their value become increasingly necessary. Interpretative phenomenological analysis (IPA) is a distinctive approach to conducting qualitative research being used with increasing frequency in published studies. A systematic literature review was undertaken to identify published papers in the area of health psychology employing IPA. A total of 52 articles are reviewed here in terms of the following: methods of data collection, sampling, assessing wider applicability of research and adherence to the theoretical foundations and procedures of IPA. IPA seems applicable and useful in a wide variety of research topics. The lack of attention sometimes afforded to the interpretative facet of the approach is discussed