A Brief Music App to Address Pain in the Emergency Department: Prospective Study

BACKGROUND: Emergency physicians face the challenge of relieving acute pain daily. While opioids are a potent treatment for pain, the opioid epidemic has ignited a search for nonopioid analgesic alternatives that may decrease the dose or duration of opioid exposure. While behavioral therapies and complementary medicine are effective, they are difficult to deploy in the emergency department. Music is a potential adjunctive therapy that has demonstrated effectiveness in managing pain. OBJECTIVE: Our objective was to understand the feasibility and potential for an effect of a novel music app to address acute pain and anxiety in patients admitted to an emergency department observation unit. METHODS: This prospective cohort study enrolled patients admitted to an emergency department observation unit with pain who had received orders for opioids. We gathered baseline pain and psychosocial characteristics including anxiety, sleep disturbance, and pain catastrophizing using validated questionnaires. Participants received a smartphone-based music intervention and listened to the music in either a supervised (research assistant-delivered music session 3 times during their stay) or unsupervised manner (music used ad lib by participant). The app collected premusic and postmusic pain and anxiety scores, and participants provided qualitative feedback regarding acceptability of operating the music intervention. RESULTS: We enrolled 81 participants and randomly assigned 38 to an unsupervised and 43 to a supervised group. Mean pain in both groups was 6.1 (1.8) out of a possible score of 10. A total of 43 (53%) reported previous use of music apps at home. We observed an overall modest but significant decrease in pain (mean difference -0.81, 95% CI -0.45 to -1.16) and anxiety (mean difference -0.72, 95% CI -0.33 to -1.12) after music sessions. Reduction of pain and anxiety varied substantially among participants. Individuals with higher baseline pain, catastrophizing (about pain), or anxiety reported greater relief. Changes in pain were correlated to changes in anxiety (Pearson ?=0.3, P=.02) but did not vary between supervised and unsupervised groups. Upon conclusion of the study, 46/62 (74%) reported they liked the music intervention, 57/62 (92%) reported the app was easy to use, and 49/62 (79%) reported they would be willing to use the music intervention at home. CONCLUSIONS: A smartphone-based music intervention decreased pain and anxiety among patients in an emergency department observation unit, with no difference between supervised and unsupervised use. Individuals reporting the greatest reduction in pain after music sessions included those scoring highest on baseline assessment of catastrophic thinking, suggesting there may be specific patient populations that may benefit more from using music as an analgesic adjunct in the emergency department. Qualitative feedback suggested that this intervention was feasible and acceptable by emergency department patients

Folha diagnótica para avaliação do estado nutricional do feijoeiro Diagnostic leaf for evaluation of the nutritional status of bean

O feijoeiro é uma planta exigente em nutrientes, seja devido ao pequeno e pouco profundo sistema radicular, seja devido ao ciclo curto. Partindo de um trabalho com doses de calcário e boro, realizaram-se correlações entre dois tipos de folha (+1 e +3) do feijoeiro, com os teores dos elementos presentes nas plantas e na produção, objetivando-se estabelecer a folha mais adequada para a diagnose foliar. O experimento foi desenvolvido em condições de casa de vegetação empregando-se sementes de feijoeiro cv. BRS Talismá. As doses de calcário empregadas considerando-se a saturação por bases igual a 70%, foram calculadas como: zero de calcário, metade da dose padrão, dose para elevar V = 70% (padrão), uma vez e meia a dose e duas vezes a dose padrão enquanto para o boro as quantidades aplicadas foram: zero; 0,6; 1,2; 1,8 e 2,4 mg de B dm-3. Realizaram-se, no momento do florescimento, a coleta das folhas diagnóticas +1 e +3 (folhas amadurecidas a partir do ápice); a coleta de uma planta (parte aérea) por vaso e a mensuração da produção. Através de correlações constataram-se, para os nutrientes alvo do estudo, cálcio, magnésio e boro em que a folha +3 apresentou maiores coeficientes de correlação com os teores na planta e com os dados de produção.<br>The bean is a nutrient demanding plant, either due to the small and shallow root system or due to the short cycle. A study with doses of lime and boron was conducted and correlations were made between two types of leaf (+1 and +3) of the bean with the contents of these elements in plants and production, aiming to establish the most appropriate leaf for diagnosis of nutritional status. The experiment was conducted in greenhouse conditions employing bean seeds cv. BRS Talismá. Lime rates considering the saturation of bases (70%), were calculated as zero, half the standard dose, dose to increase V = 70% (default), one and a half and twice the standard dose, while the boron amounts used were: zero, 0.6, 1.2, 1.8 and 2.4 mg B dm-3. At the time of flowering, diagnostic leaves +1 and +3 (mature leaves from the apex) were collected along with sampling of a plant (aerial part) per pot and the measurement of production. Through correlations it was verified that nutrients, calcium, magnesium and boron in the leaf +3 showed higher correlation coefficients with levels in the plant and production data