The Utility of Music-based Interventions in Dementia Care

While research has investigated the impact of music-based interventions on management of behavioral and psychological symptoms of dementia (BPSD), there is limited discussion of which music-based interventions are most effective for various levels of dementia severity, or of how to determine which music-based interventions are both accessible and feasible for caregivers and nursing staff. This review sought to identify the benefits of music-based interventions in dementia care within various domains of functioning and determine whether music-based interventions are effective for various levels of dementia severity. Peer-reviewed articles and studies that evaluated the effectiveness of various music interventions or demonstrated music\u27s impact on cognitive, behavioral, psychological, or social functioning for individuals with various levels of dementia were examined in this review. Most studies reviewed demonstrated that music-based interventions might yield improvements in various aspects of cognitive, behavioral, psychological, and social functioning across all levels of dementia severities. Due to the heterogeneity of methods and limitations of study designs, research is unable to demonstrate a systematic approach to selecting music interventions based on dementia severity. However, current patterns in the literature support recommendations for caregivers and nursing staff in individualizing music-based interventions for individuals with dementia

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used