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Almarzouq SSFS, Chua H, Yiu CKY, Lam PPY. Effectiveness of Nonpharmacological Behavioural Interventions in Managing Dental Fear and Anxiety among Children: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2024; 12:537. [PMID: 38470648 PMCID: PMC10931341 DOI: 10.3390/healthcare12050537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/03/2024] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Non-pharmacological behavioural interventions (NPBIs) have been employed by dentists to alleviate dental fear and anxiety (DFA) among preschool and school children. The aim of this systematic review and meta-analysis was to investigate the effectiveness of different NPBIs in reducing DFA among children aged below 12. METHOD A comprehensive search was conducted using four electronic databases to identify randomised controlled trials that assess the effectiveness of NPBIs among preschool and school children. Two reviewers independently screened and selected the relevant studies, evaluated the risk of bias, and extracted relevant data for qualitative and quantitative syntheses. RESULT A total of 66 articles were included in the study. Except during more invasive dental procedures, the use of distraction techniques was found to result in significantly lower self-rated anxiety, better cooperation, and lower pulse rate compared to the tell-show-do method. However, inconsistent results were reported regarding the efficacy of virtual reality, modelling, visual pedagogies, tell-show-do and other NPBIs in reducing DFA among children. CONCLUSIONS The studies exhibited substantial heterogeneity due to varying age groups, methods of implementing NPBIs, dental treatments performed, and measurement scales employed in the evaluation of DFA.
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Affiliation(s)
| | - Helene Chua
- National Healthcare Group Polyclinics, Singapore 308433, Singapore
| | - Cynthia K. Y. Yiu
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong (C.K.Y.Y.)
| | - Phoebe P. Y. Lam
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong (C.K.Y.Y.)
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Arslan HN, Çelik SŞ. Nonpharmacological Nursing Interventions in Postoperative Nausea and Vomiting: A Systematic Review. J Perianesth Nurs 2024; 39:142-154. [PMID: 37865902 DOI: 10.1016/j.jopan.2023.06.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE This study aims to assess the impact of nonpharmacological nursing interventions on postoperative nausea and vomiting (PONV). DESIGN This is a systematic review. METHODS MEDLINE, Web of Science, ScienceDirect, Tübitak-ULAKBİM, and TRDizin databases were searched for the following search terms, including "Postoperative Nausea and Vomiting," "Nurse," "Nursing," and "Nonpharmacological Interventions" to identify nonpharmacological nursing interventions for PONV. A systematic review of English and Turkish articles published in the period between January 1, 2012 and June 1, 2023 was conducted. The PICOT-SD method was used to determine the compatibility of the pieces with the eligibility criteria. FINDINGS Fifty-eight of 3,874 articles obtained from databases fulfilled the eligibility criteria. This study demonstrated that acupuncture, aromatherapy, the oral intake of ginger, listening to music, education, and visits to patients decreased the incidence of nausea and vomiting and increased the quality of life. Additionally, it was found that patients' quality of life tended to improve along with reductions in postoperative complications. CONCLUSIONS The results of this study support previous findings in the literature and demonstrate that nonpharmacological nursing interventions help reduce and prevent PONV. Based on our results, we suggest that nonpharmacological nursing interventions can be employed for the management of PONV in patients undergoing surgery.
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Raiber L, Raff C, Thiele J, Kramer K. Integrative Nursing Interventions for Cancer-Related Symptoms in Oncology Inpatients: Results of a Descriptive Pilot Study. Integr Cancer Ther 2024; 23:15347354241239930. [PMID: 38680047 PMCID: PMC11057344 DOI: 10.1177/15347354241239930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/05/2024] [Accepted: 03/01/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Integrative nursing (IN) is an essential component of integrative medicine and integrative oncology. IN includes a range of external naturopathic, integrative nursing interventions, such as compresses, embrocation, and foot/hand baths, aimed at alleviating symptoms and side effects of conventional treatment. The project IMPLEMENT-UKU ("Implementation of IN at the University Hospital Ulm") was accompanied by a descriptive pilot study on the use of IN interventions on cancer-related symptoms in oncology inpatients, the characterization of these patients and the evaluation of the impact. METHODS A single-arm study was conducted using a paper-based questionnaire administered before the IN interventions (t0) and 24 hours after the IN interventions (t1). Topics included sociodemographic data, symptoms, quality of life, health status, psychological burden, attitudes, and experience and satisfaction with the IN interventions. Analyses were descriptive using absolute and relative frequencies. RESULTS During the 6-month study period out of 66 patients recommended for IN consultation by medical and nursing staff on 2 wards, 62 (93.9%) accepted the offer. Of those patients who received IN, 21 patients (33.9%) participated in the study. The number of IN interventions received per patient ranged from 1 to 3 during the 24-hour survey period. And a total of 36 IN interventions were performed: The most treated body region was the feet/legs (50.0%), followed by the back (25.0%), using oils such as solum oil (41.7%) and lavender oil (13.9%). Embrocation (77.8%) was the predominant type of IN intervention. For patients, the mean FACIT-F score was 29.2 ± 12.5. The mean PHQ-4 score was 3.0 ± 1.9. Regarding sleep quality in the last 4 weeks, 13 participants (61.9%) described it as rather or very poor. Satisfaction with the IN was high, with a large proportion of participants evaluating the IN interventions very positively. CONCLUSION The study's findings suggest that there is a great need for IN among oncology inpatients. These patients are open to and interested in IN interventions and evaluate them positively. IN provides a promising opportunity to provide non-pharmacological support to inpatients. The integration of IN in conventional oncology care settings may enhance patient-centered care and contribute to improved patient wellbeing.
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Affiliation(s)
- Lea Raiber
- University Hospital Ulm, Ulm, Germany
- Interprofessional Graduate School for Integrative Medicine and Health, Witten/Herdecke University, Germany
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Hamaguchi R, Hirokawa Y, Takahashi H, Hachiya T, Kawano H, Isotani S, Ito E, Handa N, Saito R, Horie S, Ide H. Retrospective observational study of a novel smartphone app on the management of patients with mild cognitive impairment or mild dementia. Front Digit Health 2023; 5:1243253. [PMID: 37767524 PMCID: PMC10520957 DOI: 10.3389/fdgth.2023.1243253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction In this study, we aimed to evaluate the feasibility, utility, and potential effects of LQ-M/D App, a smartphone application developed by Life Quest Inc., Tokyo, Japan, for patients with mild cognitive impairment (MCI) and mild dementia. The app incorporates cognitive and physical exercise training, lifestyle habit acquisition features, and a continuity improvement feature added in the post-update version to enhance user engagement. The continuity improvement feature includes the optimization of training content, and disease education, and enables family monitoring via a family app. Methods A retrospective analysis was conducted on app usage, cognitive and exercise training implementation and interruptions, questionnaire response rates, and cognitive assessments in a single institution. A total of 20 patients used the app, with 10 patients using the pre-update version without the continuity improvement feature, and the other 10 patients using the post-update version with the continuity improvement feature. Results and Conclusion The results demonstrated that the LQ-M/D App could be effectively used by the study population, and the continuity improvement feature positively influenced app usage in several aspects. Although a potential association between app usage and cognitive ability was suggested, the scatter in the data points warrants cautious interpretation. Limitations of the study included a small sample size, a single institution setting, and the retrospective nature of the study. In the future, a randomized controlled trial design using a larger sample size and multiple institutions to further evaluate the effectiveness of LQ-M/D App in managing MCI and mild dementia should be performed.
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Affiliation(s)
- Reo Hamaguchi
- Department of Digital Therapeutics, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | | | - Hirotsugu Takahashi
- Department of Digital Therapeutics, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Tsuyoshi Hachiya
- Department of Advanced Informatics for Genetic Disease, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Haruna Kawano
- Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Shuji Isotani
- Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Emi Ito
- Department of Digital Therapeutics, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Nobuhiro Handa
- Department of Digital Therapeutics, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | | | - Shigeo Horie
- Department of Digital Therapeutics, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Hisamitsu Ide
- Department of Digital Therapeutics, Graduate School of Medicine, Juntendo University, Tokyo, Japan
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He CC, Lin DM, Liu HZ, Wang FF, Guo XF, Zhang XB, Ai YQ, Meng LM. Nonpharmacological Interventions for Management of the Pain-Fatigue-Sleep Disturbance Symptom Cluster in Breast Cancer Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. J Pain Res 2023; 16:2713-2728. [PMID: 37577159 PMCID: PMC10417742 DOI: 10.2147/jpr.s409798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/09/2023] [Indexed: 08/15/2023] Open
Abstract
Background The pain-fatigue-sleep disturbance symptom cluster is commonly experienced by breast cancer patients, and a variety of nonpharmacological interventions are used to treat this symptom cluster. Objective To compare the efficacy of nonpharmacological interventions in improving the symptoms of the pain-fatigue-sleep disturbance symptom cluster in breast cancer patients. Methods A comprehensive literature search was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, CNKI, and Wanfang databases to identify randomized controlled studies from database inception to May 2022. Two reviewers independently performed data retrieval and risk of bias assessments. The consistency model was used to conduct network meta-analyses (NMA) based on the frequentist framework to assess the interventions, which were ranked by the surface under the cumulative ranking curve (SUCRA). Finally, the CINeMA application was used to evaluate the results of the NMA and the evidence of quality. The results Twenty-three eligible studies assessing 14 interventions were included. According to SUCRA values, among the management effects of the three symptoms, the effect of progressive muscle relaxation (PMR) ranked first, followed by mindfulness-based stress reduction (MBSR). The overall evidence quality of our study ranges from very low to moderate. Conclusion PMR and MBSR were effective interventions for the pain-fatigue-sleep disturbance symptom cluster in breast cancer patients. Clinical recommendations prioritize PMR for symptom management, followed by MBSR. However, this should be interpreted cautiously, as the confidence in the evidence was not high.
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Affiliation(s)
- Cong-Cong He
- School of Nursing, Gannan Medical University, Ganzhou City, Jiangxi Province, People’s Republic of China
| | - Dong-Mei Lin
- School of Nursing, Gannan Medical University, Ganzhou City, Jiangxi Province, People’s Republic of China
| | - Hui-Zhen Liu
- School of Nursing, Gannan Medical University, Ganzhou City, Jiangxi Province, People’s Republic of China
| | - Fei-Fei Wang
- School of Nursing, Gannan Medical University, Ganzhou City, Jiangxi Province, People’s Republic of China
| | - Xiu-Fang Guo
- School of Nursing, Gannan Medical University, Ganzhou City, Jiangxi Province, People’s Republic of China
| | - Xiao-Bo Zhang
- School of Nursing, Gannan Medical University, Ganzhou City, Jiangxi Province, People’s Republic of China
| | - Yi-Qin Ai
- School of Nursing, Gannan Medical University, Ganzhou City, Jiangxi Province, People’s Republic of China
| | - Li-Min Meng
- School of Nursing, Gannan Medical University, Ganzhou City, Jiangxi Province, People’s Republic of China
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Mavragani A, Tchao D, Lewis-Fung S, Pardini S, Harris LR, Appel L. Virtual Reality Therapy for People With Epilepsy and Related Anxiety: Protocol for a 3-Phase Pilot Clinical Trial. JMIR Res Protoc 2023; 12:e41523. [PMID: 36692939 PMCID: PMC9906303 DOI: 10.2196/41523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Anxiety is one of the most common psychiatric comorbidities in people with epilepsy and often involves fears specifically related to the condition, such as anxiety related to the fear of having another seizure. These epilepsy- or seizure-related fears have been reported as being more disabling than the seizures themselves and significantly impact quality of life. Although research has suggested that exposure therapy (ET) is helpful in decreasing anxiety in people with epilepsy, no research to our knowledge has been conducted on ET in people with epilepsy using virtual reality (VR). The use of novel technologies such as an immersive VR head-mounted display for ET in this population offers several benefits. Indeed, using VR can increase accessibility for people with epilepsy with transportation barriers (eg, those who live outside urban centers or who have a suspended driver's license owing to their condition), among other advantages. In the present research protocol, we describe the design of an innovative VR-ET program administered in the home that focuses on decreasing anxiety in people with epilepsy, specifically anxiety related to their epilepsy or seizures. OBJECTIVE Our primary objective is to examine the feasibility of the study protocol and proposed treatment as well as identify suggestions for improvement when designing subsequent larger clinical trials. Our secondary objective is to evaluate whether VR-ET is effective in decreasing anxiety in a pilot study. We hypothesize that levels of anxiety in people with epilepsy will decrease from using VR-ET. METHODS This mixed methods study comprises 3 phases. Phase 1 involves engaging with those with lived experience through a web-based questionnaire to validate assumptions about anxiety in people with epilepsy. Phase 2 involves filming videos using a 360° camera for the VR-ET intervention (likely consisting of 3 sets of scenes, each with 3 intensity levels) based on the epilepsy- and seizure-related fears most commonly reported in the phase 1 questionnaire. Finally, phase 3 involves evaluating the at-home VR-ET intervention and study methods using a series of validated scales, as well as semistructured interviews. RESULTS This pilot study was funded in November 2021. Data collection for phase 1 was completed as of August 7, 2022, and had a final sample of 18 participants. CONCLUSIONS Our findings will add to the limited body of knowledge on anxiety in people with epilepsy and the use of VR in this population. We anticipate that the insights gained from this study will lay the foundation for a novel and accessible VR intervention for this underrecognized and undertreated comorbidity in people with epilepsy. TRIAL REGISTRATION ClinicalTrials.gov NCT05296057; https://clinicaltrials.gov/ct2/show/NCT05296057. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41523.
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Affiliation(s)
| | | | | | - Susanna Pardini
- OpenLab, University Health Network, Toronto, ON, Canada.,Department of General Psychology, University of Padova, Padova, Italy.,Digital Health Lab, Centre for Health and Wellbeing, Bruno Kessler Foundation, Trento, Italy
| | | | - Lora Appel
- OpenLab, University Health Network, Toronto, ON, Canada.,School of Health Policy & Management, York University, Toronto, ON, Canada.,Michael Garron Hospital, Toronto, ON, Canada
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Yang H, Lv Z, Xu Y, Chen H. Leisure-Related Social Work Interventions for Patients with Cognitive Impairment: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2023; 20:1906. [PMID: 36767272 PMCID: PMC9915088 DOI: 10.3390/ijerph20031906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
The social work profession has been exploring nonpharmacological interventions for patients with cognitive impairment, but there are few evidence-based research outputs. Systematically evaluating the effectiveness of social work interventions for people with cognitive impairment can shed light on the matter to further improve similar interventions. Randomized controlled trials of nonpharmacological interventions for patients with cognitive impairment were selected from key literature databases in both English and Chinese from 2010 to 2021. A systematic review and meta-analysis with Revman 5.4 were performed. Seven trials were included, involving 851 patients with cognitive impairment. The meta-analysis showed that, in terms of overall cognitive function, the Montreal Cognitive Assessment score (MD = 1.64, 95% CI [0.97, 2.30], p < 0.001) of the intervention group was superior to the control group, but there was no significant difference in the Mini-Mental State Examination score between the two groups (MD = 0.33, 95% CI [-0.16, 0.82], p = 0.18). Compared with the control group, nonpharmacological intervention can effectively improve the neuropsychiatric condition of patients (SMD = -0.42, 95% CI [-0.64, -0.20], p = 0.0002). In summary, the current evidence shows that nonpharmacological social work interventions had a positive effect on the cognitive function and neuropsychiatric status of patients with cognitive impairment. Suggestions for future nonpharmacological intervention practice are discussed.
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Affiliation(s)
- Hui Yang
- Department of Sociology and Social Work, Minzu University of China, No. 27 Zhongguancun S St, Haidian, Beijing 100081, China
| | - Zhezhen Lv
- Department of Sociology and Social Work, Minzu University of China, No. 27 Zhongguancun S St, Haidian, Beijing 100081, China
| | - Yuyue Xu
- Department of Sociology and Social Work, Minzu University of China, No. 27 Zhongguancun S St, Haidian, Beijing 100081, China
| | - Honglin Chen
- Department of Social Sciences, University of Eastern Finland; Yliopistonranta 1, P.O. Box 1627, FI-70211 Kuopio, Finland
- Department of Social Work, Fudan University, No.220 Han Dan Road, Shanghai 200433, China
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Akrour R, Courret-Gilgen C, Perrenoud B. Prevention and management of behavioural and psychological symptoms in patients with dementia in acute care: a best practice implementation project. JBI Evid Implement 2022; 20:289-300. [PMID: 36375022 DOI: 10.1097/XEB.0000000000000329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Behavioural and psychological symptoms of dementia are very common in acute care. Agitation and aggressive behaviours are the most common symptoms and are challenging to manage. Early detection and a nonpharmacological approach are recommended. OBJECTIVES To implement evidence-based recommendations for the prevention and management of aggression/agitation in patients with dementia in an acute geriatric care unit. METHODS The project used the JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool. A baseline audit was conducted with seven audit criteria based on evidence summaries. It was followed by the implementation of an action plan and a follow-up audit. RESULTS Results showed moderate improvements in compliance with best practice recommendations. The second audit indicated an improvement up to 46% with the identification of factors/triggers that precipitate aggression/agitation and completion of a risk assessment. The highest improvement was the training of the nursing team (79%). Compliance with the involvement of patients and their families in the care planning improved slightly (14%). The lowest improvement was for the development and implementation of individualized care plans (10%). CONCLUSION The project implementation achieved some positive changes. A formalized process for preventing aggression/agitation is in place. The interprofessional collaboration, the support given to the nursing team and the basket of nonpharmacological interventions were strengthened. The electronic documentation and a limited collaboration of the nursing team were challenging. As further strategies were implemented, further audit would be required to assess achievement in change and/or demonstration of improved care provided for this vulnerable population.
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Shah VV, Vitorio R, Hasegawa N, Carlson-Kuhta P, Nutt JG, King LA, Mancini M, Horak FB. Effects of a Cognitively Challenging Agility Boot Camp Program on Balance and Gait in People With Parkinson's Disease: Does Freezing of Gait Status Matter? Neurorehabil Neural Repair 2022; 36:603-612. [PMID: 36004814 DOI: 10.1177/15459683221119757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIM Individuals with Parkinson's disease (PD) with and without freezing of Gait (FoG) may respond differently to exercise interventions for several reasons, including disease duration. This study aimed to determine whether both people with and without FoG benefit from the Agility Boot Camp with Cognitive Challenges (ABC-C) program. METHODS This secondary analysis of our ABC-C trial included 86 PD subjects: 44 without FoG (PD-FoG) and 42 with FoG (PD + FoG). We collected measures of standing sway balance, anticipatory postural adjustments, postural responses, and a 2-minute walk with and without a cognitive task. Two-way repeated analysis of variance, with disease duration as covariate, was used to investigate the effects of ABC-C program. Effect sizes were calculated using standardized response mean (SRM) for PD-FoG and PD + FoG, separately. RESULTS The ABC-C program was effective in improving gait performance in both PD-FoG and PD + FoG, even after controlling for disease duration. Specifically, dual-task gait speed (P < .0001), dual-cost stride length (P = .012), and these single-task measures: arm range of motion (P < .0001), toe-off angle (P = .005), gait cycle duration variability (P = .019), trunk coronal range of motion (P = .042), and stance time (P = .046) improved in both PD-FoG and PD + FoG. There was no interaction effect between time (before and after exercise) and group (PD-FoG/PD + FoG) in all 24 objective measures of balance and gait. Dual-task gait speed improved the most in PD + FoG (SRM = 1.01), whereas single-task arm range of motion improved the most in PD-FoG (SRM = 1.01). CONCLUSION The ABC-C program was similarly effective in improving gait (and not balance) performance in both PD-FoG and PD + FoG.
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Affiliation(s)
- Vrutangkumar V Shah
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Rodrigo Vitorio
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, UK
| | - Naoya Hasegawa
- Department of Rehabilitation Science, Hokkaido University, Sapporo, Hokkaido, Japan
| | | | - John G Nutt
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- APDM Wearable Technologies, A Clario company, Portland, OR, USA
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Malhotra B, Haith LR, Stair-Buchmann M, Kaimal G. "Through the fire and flames, we carry on:" Art Therapy Small N Feasibility Study with Adult Burn Patients in an Acute Care Setting. J Burn Care Res 2022; 44:631-640. [PMID: 35939378 DOI: 10.1093/jbcr/irac113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Indexed: 11/13/2022]
Abstract
This study aimed to investigate the feasibility of facilitating four sessions of art therapy intervention with a primary focus on implementation and acceptability. The exploratory aim was on assessing the impact of art therapy on self-reported outcomes on anxiety and mood among 5 individuals (aged 18+ years) hospitalized for burn injuries and to understand their perceptions of engagement with art therapy. A convergent mixed methods small N design was adopted wherein both quantitative and qualitative data are gathered and then integrated, and an individual served as his/her own control when assessed before and after art therapy. Anxiety was assessed using Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety short-form of the emotional distress bank, and mood was assessed using the Positive and Negative Affect Schedule (PANAS). There was a statistically significant decrease in anxiety scores and negative mood scale. Positive mood scale scores tended to improve after art therapy though were not statistically significant. Thematic analysis of qualitative data indicates that art therapy improves a) symptom management, b) facilitates emotional expression and c) insight, d) brings out symbolic and metaphorical representations, and e) allows tactile and sensory exploration of art media. This study demonstrated that art therapy can be successfully implemented with acute burn patients and can have promising psychosocial benefits. More research in needed to determine the impact and effectiveness of art therapy with burn patients, in ways that is meaningful to the patients.
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Affiliation(s)
- Bani Malhotra
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, USA
| | - Linwood R Haith
- The Nathan Speare Regional Burn Treatment Center, Crozer-Chester Medical Center, Upland, PA, USA
| | - Megan Stair-Buchmann
- The Nathan Speare Regional Burn Treatment Center, Crozer-Chester Medical Center, Upland, PA, USA
| | - Girija Kaimal
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, USA
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Lee H, Kim E, Yoon JY. Effects of a multimodal approach to food art therapy on people with mild cognitive impairment and mild dementia. Psychogeriatrics 2022; 22:360-372. [PMID: 35229407 DOI: 10.1111/psyg.12822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 01/19/2022] [Accepted: 02/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Food art therapy (FAT) has multiple modalities in which cognition, emotion, and social changes are stimulated. The purpose of this study was to design a multimodal approach to a food art therapy (MM-FAT) program and identify its effects on cognitive ability, daily living functioning, depression, self-esteem, self-efficacy, self-expression, and social functioning in individuals with mild cognitive impairment (MCI) and mild dementia by employing a mixed methods research design. METHODS The participants included 39 patients from a public dementia care centre in Seoul, Korea. The intervention group, which comprised 20 participants, received 12 MM-FAT sessions 3 times a week for 4 weeks, and the control group, which included 19 participants, received usual care. The MM-FAT program was evaluated based on its effectiveness on cognitive, daily living, emotional, and social functioning outcome measures at three time points using repeated measures analysis of variance. Semi-structured interviews (n = 9) were conducted to evaluate the overall experience of the MM-FAT program and its outcomes. RESULTS The findings reveal that MM-FAT has a positive effect on the cognitive, emotional, and social functioning of individuals with MCI and mild dementia. However, there were no enhancements in individuals' daily living functioning, and the lasting effects of the intervention could not be assessed. Cognition and depression increased significantly at the end of the MM-FAT program. Self-expression and self-efficacy were significantly higher in the MM-FAT group than in the control group. The semi-structured interviews revealed improvements in participants' behaviour, communication, and interaction. CONCLUSION This mixed methods study focused on individuals with MCI or mild dementia contributes to an understanding of the effectiveness of a FAT program employing a multimodal approach. Despite the COVID-19 pandemic, the study was able to enrich the effects of MM-FAT on cognitive, emotional, and social functioning through qualitative findings.
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Affiliation(s)
- Hyojin Lee
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Eunjoo Kim
- Center for Human-Caring Nurse Leaders for the Future, College of Nursing, Seoul National University, Seoul, South Korea
| | - Ju Young Yoon
- College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, South Korea.,Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21(BK 21) Four Project, Seoul, South Korea
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Smith KL, Wang Y, Colloca L. Impact of Virtual Reality Technology on Pain and Anxiety in Pediatric Burn Patients: A Systematic Review and Meta-Analysis. Front Virtual Real 2022; 2:751735. [PMID: 36247202 PMCID: PMC9563984 DOI: 10.3389/frvir.2021.751735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Virtual reality (VR) has the potential to lessen pain and anxiety experienced by pediatric patients undergoing burn wound care procedures. Population-specific variables require novel technological application and thus, a systematic review among studies on its impact is warranted. OBJECTIVE The objective of this review was to evaluate the effectiveness of VR on pain in children with burn injuries undergoing wound care procedures. METHODS A systematic literature review was performed using PubMed and CINAHL databases from January 2010 to July 2021 with the keywords "pediatric," "burn," "virtual reality," and "pain." We included experimental studies of between- and within-subjects designs in which pediatric patients' exposure to virtual reality technology during burn wound care functioned as the intervention of interest. Two researchers independently performed the literature search, made judgements of inclusion/exclusion based on agreed-upon criteria, abstracted data, and assessed quality of evidence using a standardized appraisal tool. A meta-analysis was conducted to evaluate the effectiveness of the VR on burning procedural pain in pediatric population. Standardized mean difference (SMD) was used as an index of combined effect size, and a random effect model was used for meta-analysis. RESULTS Ten articles published between January 2010 and July 2021 passed the selection criteria: six randomized controlled trials and four randomized repeated-measures studies. Consistent results among the studies provided support for VR as effective in reducing pain and potentially pain related anxiety in children undergoing burn wound care through preprocedural preparation (n = 2) and procedural intervention (n = 8). VR effects on pain intensity ratings were moderate to large (SMD=0.60, 95%CI=0.28-0.93, p=0.0037 with no significant heterogeneity of VR intervention effects between studies. Only one study reported direct influence of VR intervention on pre-procedural situational anxiety with a moderate effect size (Cohen's d = 0.575, 95%CI = 0.11-1.04). CONCLUSION Children's exposure to VR during burn care procedures was associated with lower levels of pain and pain related anxiety. Moderate to large effect sizes support the integration of VR into traditional pediatric burn pain protocols irrespective of innovative delivery methods and content required for use in burned pediatric patients.
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Affiliation(s)
- Kathryn L. Smith
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, United States
| | - Yang Wang
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, United States
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD, United States
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, United States
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD, United States
- Departments of Anesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, United States
- Correspondence: Luana Colloca,
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Abstract
OBJECTIVE This randomized controlled study explored the efficacy, feasibility, and acceptability of executive function training (EFT) for preschool children with ADHD. METHOD The current study design was an 8 week randomized parallel groups, single-blinded trial, using EFT-P. A total of 96 children with an ADHD diagnosis at age 4 to 5 years old were randomized into the intervention group and waitlist group. In the intervention group, 46 out of 50 participants completed the 8-week program, compared with 39 out of 46 in the waiting group. The level of ADHD symptoms and the executive function (EF) were evaluated by both neuropsychological tests from NEPSY Second Edition (NEPSY-II) and Behavior Rating Inventory of Executive Function Preschool version (BRIEF-P). RESULTS The EFT is feasible to administer and is acceptable for preschool children, with a 93% retention rate. Results showed that following the intervention, the visual-motor precision (p = .024), ADHD diagnostic state (p = .01), and oppositional defiant symptoms (p = .023) improved significantly in preschool children. However, the symptoms of ADHD and other EF evaluations were found to be insignificant. CONCLUSION The EFT is feasible, acceptable, and potentially effective to reduce symptoms and improve EF for preschool children with ADHD. The next step is to extend the program time and provide more frequent practice of activities between the children and the therapist and/or parent, to improve the effectiveness.
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Affiliation(s)
- Lan Shuai
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China.,Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, China
| | | | - Wei Li
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China
| | | | - Shanshan Wang
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China
| | - Runsen Chen
- Central South University, Chinese National Clinical Research Centre on Mental Disorders (Xiangya), Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, China
| | - Jinsong Zhang
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China.,Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, China
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14
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Zhao L, Shi P, Xiong X, Zeng J. Nonpharmacological interventions for cancer-related fatigue in lung cancer patients: A protocol for an evidence map of overview of a network meta-analysis of existing trials. Medicine (Baltimore) 2021; 100:e26864. [PMID: 34397897 PMCID: PMC8360413 DOI: 10.1097/md.0000000000026864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Lung cancer is one of the most common cancers, the symptoms and treatment of which can cause negative emotions like anxiety, depression, and cancer-related fatigue (CRF). Nonpharmacological interventions, serving as alternative therapies, can greatly alleviate CRF in lung cancer patients. Previous meta-analyses have reported nonpharmacological interventions of CRF in lung cancer patients, but the results may be conflicting, and the reporting and methodological qualities remain unknown. Moreover, there is limited evidence to identify efficient and safe non-pharmacological interventions of CRF in lung cancer patients. This study aims to assess the therapeutic efficacy of nonpharmacological interventions of CRF in lung cancer patients through a network meta-analysis. METHODS Relevant literatures reporting non-pharmacological interventions of CRF in lung cancer patients published before June 2021 will be searched in online databases, including Wanfang, VP Information Chinese Journal Service Platform, China National Knowledge Infrastructure, Chinese BioMedicine Literature Database, PubMed, Embase, Cochrane, and Web of science. Two reviewers will be independently responsible for study selection, quality appraisal, and data extraction. Data analysis will be performed using the STATA14.0 and GEMTC 0.14.3 software. RESULTS This meta-analysis will provide additional and stronger evidences for nonpharmacological interventions of CRF in lung cancer patients. Our findings will be conductive to make therapeutic decisions by clinicians. CONCLUSION This study will provide a reliable evidence-based basis for non-pharmacological interventions of CRF in lung cancer patients. ETHICS AND DISSEMINATION Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms. This review would be disseminated in a peer-reviewed journal or conference presentations. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/QRY42.
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15
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McMaster M, Kim S, Clare L, Torres SJ, Cherbuin N, DʼEste C, Anstey KJ. Lifestyle Risk Factors and Cognitive Outcomes from the Multidomain Dementia Risk Reduction Randomized Controlled Trial, Body Brain Life for Cognitive Decline (BBL-CD). J Am Geriatr Soc 2020; 68:2629-2637. [PMID: 32909259 DOI: 10.1111/jgs.16762] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/28/2020] [Accepted: 07/08/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES To evaluate the efficacy of a multidomain intervention to reduce lifestyle risk factors for Alzheimer's disease (AD) and improve cognition in individuals with subjective cognitive decline (SCD) or mild cognitive impairment (MCI). DESIGN The study was an 8-week two-arm single-blind proof-of-concept randomized controlled trial. SETTING Community-dwelling individuals living in Canberra, Australia, and surrounding areas. PARTICIPANTS Participants were 119 individuals (intervention n = 57; control n = 62) experiencing SCD or MCI. INTERVENTION The control condition involved four educational modules covering dementia and lifestyle risk factors, Mediterranean diet, physical activity, and cognitive engagement. Participants were instructed to implement this information into their own lifestyle. The intervention condition included the same educational modules and additional active components to assist with the implementation of this information into participants' lifestyles: dietitian sessions, an exercise physiologist session, and online brain training. MEASUREMENTS Lifestyle risk factors for AD were assessed using the Australian National University-Alzheimer's Disease Risk Index (ANU-ADRI), and cognition was assessed using Alzheimer's Disease Assessment Scale-Cognitive subscale, Pfeffer Functional Activities Questionnaire, Symbol Digit Modalities Test (SDMT), Trail Making Test-B, and Category Fluency. RESULTS The primary analysis showed that the intervention group had a significantly lower ANU-ADRI score (χ2 = 10.84; df = 3; P = .013) and a significantly higher cognition score (χ2 = 7.28; df = 2; P = .026) than the control group. A secondary analysis demonstrated that the changes in lifestyle were driven by increases in protective lifestyle factors (χ2 = 12.02; df = 3; P = .007), rather than a reduction in risk factors (χ2 = 2.93; df = 3; P = .403), and cognitive changes were only apparent for the SDMT (χ2 = 6.46; df = 2; P = .040). Results were robust to intention-to-treat analysis controlling for missing data. CONCLUSION Results support the hypothesis that improvements in lifestyle risk factors for dementia can lead to improvements in cognition over a short time frame with a population experiencing cognitive decline. Outcomes from this trial support the conduct of a larger and longer trial with this participant group.
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Affiliation(s)
- Mitchell McMaster
- Centre for Research on Ageing, Health and Wellbeing (CRAHW), The Australian National University, Canberra, Australia
| | - Sarang Kim
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health (REACH), University of Exeter, Exeter, UK
| | - Susan J Torres
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health and Wellbeing (CRAHW), The Australian National University, Canberra, Australia
| | - Catherine DʼEste
- National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, Canberra, Australia.,School of Medicine and Population Health, The University of Newcastle, Newcastle, Australia
| | - Kaarin J Anstey
- Neuroscience Research Australia (NeuRA), Sydney, Australia.,School of Psychology, University of New South Wales, Randwick, NSW, Australia
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16
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Hao J, Zhu X, Bensoussan A. Effects of Nonpharmacological Interventions in Chemotherapy-Induced Peripheral Neuropathy: An Overview of Systematic Reviews and Meta-Analyses. Integr Cancer Ther 2020; 19:1534735420945027. [PMID: 32875921 PMCID: PMC7476348 DOI: 10.1177/1534735420945027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Chemotherapy-induced peripheral neuropathy (CIPN) is one of the prevalent and disabling side effects of cancer treatment. However, management strategies for CIPN currently remain elusive, with treatment restricted to neuropathic pain medications, supportive care, and chemotherapy dosing adjustments. This overview explores evidence on the potential benefits and safety of nonpharmacological interventions in preventing and treating CIPN in cancer patients. METHODS Seven databases were searched for systematic reviews of randomized controlled trials (RCTs). The methodological quality of the selected reviews was assessed by AMSTAR 2, and the quality of evidence was judged by GRADE. Twenty-eight systematic reviews were considered eligible for this review. RESULTS It was found that nonpharmacological interventions (acupuncture, exercise, herbal medicine, nutritional supplements) provided potential benefits for patients with CIPN. Furthermore, Chinese herbal medicine, administered orally or externally, significantly prevented and/or relieved the incidence and severity of CIPN in comparison to control groups (no additional treatment, placebo, and conventional western medicine). However, the quality of evidence and strength of recommendations were compromised by the inconsistencies and imprecision of included studies. The main concerns regarding the quality of systematic reviews included the lack of sufficiently rigorous a priori protocols, and the lack of protocol registration adopted in the included studies. CONCLUSIONS Though looking across reviews, Chinese herbal medicine appear generally effective in CIPN, uncertainty remains about the effects of many other nonpharmacological interventions. The evidence on what works was particularly compromised by reporting and methodological limitations, which requires further investigation to be more certain of their effects.
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Affiliation(s)
- Jie Hao
- Western Sydney University, Sydney, New South Wales, Australia
| | - Xiaoshu Zhu
- Western Sydney University, Sydney, New South Wales, Australia
| | - Alan Bensoussan
- Western Sydney University, Sydney, New South Wales, Australia
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17
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Demange M, Pino M, Kerhervé H, Rigaud AS, Cantegreil-Kallen I. Management of acute pain in dementia: a feasibility study of a robot-assisted intervention. J Pain Res 2019; 12:1833-1846. [PMID: 31289446 PMCID: PMC6565935 DOI: 10.2147/jpr.s179640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/18/2019] [Indexed: 12/28/2022] Open
Abstract
Background: The management of pain is particularly challenging in patients with moderate to severe dementia owing to the loss of communication ability or underlying causes such as behavioral symptoms. It is often associated with health care professionals’ frustration and feeling of helplessness. The present study determined a framework and examined the feasibility of an innovative intervention using the PARO®
robot for the management of acute pain in dementia. Method: A mixed-methods research design combining qualitative (five focus groups) and quantitative (questionnaire survey) approaches was used to define the intervention framework. We recruited 57 health care professionals from various medical and paramedical specialties (eg, nursing auxiliaries, nurses, physicians, psychologists) and with expertise in gerontology. The feasibility of the intervention was subsequently assessed with 12 patients suffering from dementia in painful situations to validate the procedure. Results: Four main issues have been addressed: 1) the identification of a core group of painful situations associated with care (washing, dressing/change, transfer/mobilization), currently considered as inefficiently managed; 2) the selection of an appropriate assessment methodology including criteria and tools for pain evaluation; 3) the definition of health professionals' training needs and organizational requirements for their implementation; and 4) the perceived usefulness of a robot-assisted intervention for the management of pain in dementia in daily practice. The feasibility study showed that the predefined intervention framework was applicable and acceptable for the majority of professionals and patients. Conclusion: A consistent and feasible intervention framework for the management of painful situations associated with care in dementia using the PARO robot was defined. Understanding of professionals’ needs, opinions and perceived obstacles regarding the intervention was a useful step in the preparation of the forthcoming clinical trial.
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Affiliation(s)
- Manon Demange
- Department of Geriatrics, Broca Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Research Team 4468, Paris Descartes University, Paris, France
| | - Maribel Pino
- Department of Geriatrics, Broca Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Research Team 4468, Paris Descartes University, Paris, France
| | - Hélène Kerhervé
- Department of Geriatrics, Broca Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Research Team 4468, Paris Descartes University, Paris, France
| | - Anne-Sophie Rigaud
- Department of Geriatrics, Broca Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Research Team 4468, Paris Descartes University, Paris, France
| | - Inge Cantegreil-Kallen
- Department of Geriatrics, Broca Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Research Team 4468, Paris Descartes University, Paris, France
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18
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Clare L, Kudlicka A, Oyebode JR, Jones RW, Bayer A, Leroi I, Kopelman M, James IA, Culverwell A, Pool J, Brand A, Henderson C, Hoare Z, Knapp M, Woods B. Individual goal-oriented cognitive rehabilitation to improve everyday functioning for people with early-stage dementia: A multicentre randomised controlled trial (the GREAT trial). Int J Geriatr Psychiatry 2019; 34:709-721. [PMID: 30724405 PMCID: PMC6593854 DOI: 10.1002/gps.5076] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/28/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine whether individual goal-oriented cognitive rehabilitation (CR) improves everyday functioning for people with mild-to-moderate dementia. DESIGN AND METHODS Parallel group multicentre single-blind randomised controlled trial (RCT) comparing CR added to usual treatment (CR) with usual treatment alone (TAU) for people with an ICD-10 diagnosis of Alzheimer, vascular or mixed dementia, and mild-to-moderate cognitive impairment (Mini-Mental State Examination [MMSE] score ≥ 18), and with a family member willing to contribute. Participants allocated to CR received 10 weekly sessions over 3 months and four maintenance sessions over 6 months. Participants were followed up 3 and 9 months post randomisation by blinded researchers. The primary outcome was self-reported goal attainment at 3 months. Secondary outcomes at 3 and 9 months included informant-reported goal attainment, quality of life, mood, self-efficacy, and cognition and study partner stress and quality of life. RESULTS We randomised (1:1) 475 people with dementia; 445 (CR = 281) were included in the intention to treat analysis at 3 months and 426 (CR = 208) at 9 months. At 3 months, there were statistically significant large positive effects for participant-rated goal attainment (d = 0.97; 95% CI, 0.75-1.19), corroborated by informant ratings (d = 1.11; 95% CI, 0.89-1.34). These effects were maintained at 9 months for both participant (d = 0.94; 95% CI, 0.71-1.17) and informant (d = 0.96; 95% CI, 0.73-1.2) ratings. The observed gains related to goals directly targeted in the therapy. There were no significant differences in secondary outcomes. CONCLUSIONS CR enables people with early-stage dementia to improve their everyday functioning in relation to individual goals targeted in the therapy.
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Affiliation(s)
- Linda Clare
- Centre for Research in Ageing and Cognitive HealthUniversity of ExeterExeterUK
| | - Aleksandra Kudlicka
- Centre for Research in Ageing and Cognitive HealthUniversity of ExeterExeterUK
| | - Jan R. Oyebode
- School of Dementia StudiesUniversity of BradfordBradfordUK
| | | | - Antony Bayer
- Division of Population Medicine, Cardiff UniversityUniversity Llandough HospitalPenarthUK
| | - Iracema Leroi
- Department of Neuroscience and Experimental Psychology, Jean McFarlane BuildingUniversity of ManchesterManchesterUK
| | - Michael Kopelman
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, St Thomas' HospitalKing's College LondonLondonUK
| | - Ian A. James
- Centre of the Health of the ElderlyNorthumberland Tyne and Wear NHS Foundation TrustNewcastle upon TyneUK
| | - Alison Culverwell
- Kent and Medway NHS Partnership TrustSt Martin's HospitalCanterburyUK
| | | | - Andrew Brand
- North Wales Organisation for Randomised Trials in HealthBangor UniversityBangorUK
| | - Catherine Henderson
- Personal Social Services Research UnitLondon School of Economics and Political ScienceLondonUK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in HealthBangor UniversityBangorUK
| | - Martin Knapp
- Personal Social Services Research UnitLondon School of Economics and Political ScienceLondonUK
| | - Bob Woods
- Dementia Services Development CentreBangor UniversityBangorUK
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19
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Ghanbari-Homayi S, Hasani S, Meedya S, Asghari Jafarabadi M, Mirghafourvand M. Nonpharmacological approaches to improve women's childbirth experiences: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2019; 34:479-491. [PMID: 30983443 DOI: 10.1080/14767058.2019.1608434] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Childbirth is considered a significant experience in women's life. Different models of care and interventions without pharmacological approaches have been used to enhance women's positive childbirth experiences, but the most effective interventions have not been clearly identified.Objective: To assess the effectiveness of nonpharmacological approaches in improving women's childbirth experiences.Methods: We searched Cochrane Library, Medline, Web of Science, Embase, Scopus, ProQuest, Google Scholar, and Persian databases (Magiran, Scientific Information Database, and Barakat) from inception until December 2017. Randomized controlled trials and quasi-randomized controlled trials comparing interventions designed to improve women's childbirth experiences with standard cares were included in this review. Pharmacological interventions were excluded from the study. The outcome measure was women's childbirth experience. Heterogeneity was determined using the Cochrane's test and I2 index. The standardized mean differences were pooled based on random effect models.Results: We included 19 studies (10,141 women) in the review. Results of the meta-analysis of 18 studies (8487 women) demonstrated that all the interventions with nonpharmacological approaches improved childbirth experiences (standardized mean difference: 0.49; 95% confidence interval: 0.33-0.66). But, subgroup meta-analysis showed that different models of midwifery care, support during labor and natural therapies were the most effective interventions in improving women's childbirth experience.Conclusions: Nonpharmacological interventions that enable women to feel supported, safe and respected can lead to improved childbirth experiences. However, there is a need for further studies with larger sample sizes and standardized tool to better assess the effectiveness of specific interventions on women's childbirth experiences.
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Affiliation(s)
- Solmaz Ghanbari-Homayi
- Students' Research Committee, Midwifery Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sonia Hasani
- Students' Research Committee, Midwifery Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahla Meedya
- Member of South Asia Infant Feeding Research Network (SAIFRN), School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Mohammad Asghari Jafarabadi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Litrownik D, Gilliam E, Berkowitz D, Yeh GY, Wayne PM. Reporting of Protocol Rationale and Content Validity in Randomized Clinical Trials of T'ai Chi: A Systematic Evaluation. J Altern Complement Med 2019; 25:370-376. [PMID: 30835135 DOI: 10.1089/acm.2018.0389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mind-body exercise interventions are typically multimodal, complex, and pluralistic, and few have been developed with the goal of therapeutically targeting a specific medical population. It is thus important that clinical trials evaluating mind-body interventions provide some justification for the use of the specific protocol being evaluated. OBJECTIVES This article reports the results of a systematic review of the quality of reporting of protocol rationale and content validity for using a specific t'ai chi protocol in a randomized controlled trial (RCT). METHODS Electronic literature searches were conducted using PubMed/MEDLINE, EBSCOhost, and the Cochrane Library from inception through June 2015. Search terms were Tai Chi, Taiji, Tai Chi Chuan; searches were limited to English-language RCTs. Inclusion and exclusion of trials were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors assessed the level of reporting with respect to t'ai chi protocol validation using a 5-point grading system based on whether (1) a specific protocol was mentioned, (2) rationale for the specific protocol was stated and supported, and (3) formal evaluation for content validity was conducted. RESULTS There was significant heterogeneity in the quality of reporting related to protocol rationale and content validity. A total of 171 publications were identified. Studies met between 0 and 4 validity criteria (of possible 5, more indicating better quality), with a mean of 2.52 (±SD 1.2) and median of 3. Twenty (12%) trials did not mention a specific t'ai chi protocol, 10 (6%) trials met 0 of 5 criteria, and 47 (31%) studies met 4 of 5 criteria. Formal validity assessments were employed in only one trial. CONCLUSIONS The poor quality of protocol rationale and content validity reporting limits our ability to accurately evaluate the evidence of t'ai chi as a therapeutic intervention. The development of formal guidelines for developing and reporting intervention validity for multimodal mind-body exercises like t'ai chi may improve the quality and interpretability of research.
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Affiliation(s)
- Daniel Litrownik
- 1 Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Elizabeth Gilliam
- 1 Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Danielle Berkowitz
- 1 Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Gloria Y Yeh
- 1 Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Peter M Wayne
- 2 Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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21
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Sharma M, Singh A, Dhillon MS, Kaur S. Comparative Impact of Nonpharmacological Interventions on Pain of Knee Osteoarthritis Patients Reporting at a Tertiary Care Institution: A Randomized Controlled Trial. Indian J Palliat Care 2018; 24:478-485. [PMID: 30410261 PMCID: PMC6199827 DOI: 10.4103/ijpc.ijpc_14_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Context: Nonpharmacological interventions (NPIs) have been advocated for knee osteoarthritis (KOA). There are many gaps in the evidence to their efficacy in India. Aims: The study aims to compare the impact of two packages of NPIs on various outcome variables of KOA patients. Settings and Design: This was a randomized controlled trial in a tertiary care hospital. Subjects and Methods: A study population (n = 123) of KOA patients aged 40–65 years. Stratified block randomization was done for mild or moderate KOA into two groups. Group “A” patients received a package of NPIs including a set of supervised exercise sessions, kinesthesia, balance, and agility (KBA), meditation, weight reduction advice, and weekly telephonic reminders. Group “B” patients received the same package except for KBA & meditation. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) and performance-based measures were measured. Analysis: t-test and repeat measures ANOVA were undertaken. Results: A significant intragroup reduction in WOMAC score was seen from baseline in Group A (P = 0.00, mean difference: −9.7) as well as in Group B (P = 0.00, −12.9). There was also significant reduction inVAS scores at the end of intervention in Group A and Group B as compared from baseline (−3.62, −3.8, P = 0.00). No intergroup difference was observed in either of the scores. VAS score reduction to 0 at different stages of intervention was noticed in 46% (n = 57) cases. There was a significant intergroup difference for 50-Foot Walk Test (P = 0.055, F = 3.28) at 12 months. Conclusion: Both packages of NPIs were effective in providing relief in symptoms. No specific benefit of KBA or meditation was seen except for 50FWT.
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Affiliation(s)
- Meenakshi Sharma
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amarjeet Singh
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep Singh Dhillon
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sukhpal Kaur
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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22
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Mack S, Hahn S, Palli C, Findling T, Lohrmann C. Adaptation of Clinical Practice Guideline Recommendations in Hospitals for People Living With Dementia and Their Caregivers. Worldviews Evid Based Nurs 2018; 16:36-42. [PMID: 30352139 DOI: 10.1111/wvn.12334] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dementia is common in older people in general hospitals. To improve the quality of their care, the use of nonpharmacological interventions based on the best evidence from clinical guidelines is recommended. Many international clinical guidelines exist, but their recommendations are often not used because they do not fit the local setting or the country. AIM The aim of this study was to adapt the international clinical guidelines and their recommendations to the Austrian context regarding nonpharmacological interventions for people with dementia living in the general hospital setting. METHODS The ADAPTE process was chosen as a method for the adaptation. A search for international clinical guidelines was conducted in seven databases within this process. The guidelines which met the inclusion and quality criteria were assessed with the AGREE II instrument by two independent reviewers. The recommendations of the guidelines were extracted. Those that did not fit the Austrian context were excluded, and recommendations with similar statements were summarized. The selected and modified recommendations were translated into German. RESULTS Out of 206 guidelines, three met the inclusion criteria and two, the quality criteria. One hundred and fifty-two recommendations were extracted from these two guidelines, 42 of which were suitable for the Austrian setting and 20 of which had similar statements and could be summarized. Finally, 32 recommendations were identified that were applicable to the general hospital setting in Austria. LINKING EVIDENCE TO ACTION The adaptation of clinical guidelines with the ADAPTE process generated seven topics with 32 recommendations. Many international guidelines exist, but they cannot be applied verbatim in every country due to the fact that some recommendations are not applicable with respect to the national and local context. Creating an adaption of international guidelines is an effective way to provide and link evidence from research to national nursing practice.
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Affiliation(s)
- Sandra Mack
- University Hospital Graz, Graz Austria & Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Sabine Hahn
- Head of Nursing Division, Division Head of Applied Research and Development in Nursing, Bern University of Applied Sciences, Bern, Switzerland
| | - Christoph Palli
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Thomas Findling
- University Hospital Graz, Graz Austria & Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
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Shropshire M, Stapleton SJ, Dyck MJ, Kim M, Mallory C. Nonpharmacological interventions for persistent, noncancer pain in elders residing in long-term care facilities: An integrative review of the literature. Nurs Forum 2018; 53:538-548. [PMID: 30242833 DOI: 10.1111/nuf.12284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 06/05/2018] [Accepted: 07/10/2018] [Indexed: 11/28/2022]
Abstract
Elders residing in long-term care facilities experience ongoing moderate to severe pain, relief from and increased comfort remain relevant healthcare concerns. However, persistent, noncancer pain may not have been properly addressed due to insufficient attention to research that exists to support the utilization and efficacy of nonpharmacological intervention(s) for elders in long-term care facilities. Our aim of this integrated review was to evaluate the current state of the science on nonpharmacological intervention(s) for pain that are currently utilized in elders who reside in long-term care facilities. Exercise, massage, heat therapy, and relaxation/rest were identified as significant nonpharmacological interventions for persistent pain in elder residents living in long-term care facilities.
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Affiliation(s)
- Michele Shropshire
- Mennonite College of Nursing, Illinois State University, Normal, Illinois
| | | | - Mary J Dyck
- Mennonite College of Nursing, Illinois State University, Normal, Illinois
| | - Myoungjin Kim
- Mennonite College of Nursing, Illinois State University, Normal, Illinois
| | - Caroline Mallory
- College of Health and Human Services, Indiana State University, Terre Haute, Indiana
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Jones R, Kirenga BJ, Katagira W, Singh SJ, Pooler J, Okwera A, Kasiita R, Enki DG, Creanor S, Barton A. A pre-post intervention study of pulmonary rehabilitation for adults with post-tuberculosis lung disease in Uganda. Int J Chron Obstruct Pulmon Dis 2017; 12:3533-3539. [PMID: 29270007 PMCID: PMC5729823 DOI: 10.2147/copd.s146659] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Setting The study was conducted at Mulago Hospital, Kampala, Uganda. Objective As chronic respiratory disease (CRD) is a huge, growing burden in Africa, with few available treatments, we aimed to design and evaluate a culturally appropriate pulmonary rehabilitation (PR) program in Uganda for people with post-tuberculosis lung disorder (p-TBLD). Design In a pre–post intervention study, a 6-week, twice-weekly PR program was designed for people with p-TBLD. Outcome measures included recruitment, retention, the Clinical COPD Questionnaire (CCQ), tests of exercise capacity, and biometrics. Given this was a developmental study, no formal statistical significance testing was undertaken. Results In all, 34 participants started PR and 29 (85%) completed all data collection. The mean age of the 29 participants was 45 years, and 52% were female. The mean (95% confidence interval) CCQ score at baseline was 1.8 (1.5, 2.0), at the end of PR was 1.0 (0.8, 1.2), and at 6 weeks after the end of PR was 0.8 (0.7, 1.0). The Incremental Shuttle Walking Test (ISWT) was 299 m (268.5, 329.4) at baseline, 377 (339.6, 413.8) at the end of PR, and 374 (334.2, 413.5) at 6 weeks after the end of PR. Improvements were seen in measures of chest pain; 13/29 (45%) participants reported chest pain at baseline but only 7/29 (24%) at the end of PR, and in those with persistent pain, the mean pain scores decreased. Mild hemoptysis was reported in 4/29 (17%) participants at baseline and in 2/29 (7%) at the end of PR. Conclusion PR for people with p-TBLD in Uganda was feasible and associated with clinically important improvements in quality of life, exercise capacity, and respiratory outcomes. PR uses local resources, requires little investment, and offers a new, sustainable therapy for p-TBLD in resource-limited settings. With the rising global burden of CRD, further studies are needed to assess the value of PR in p-TBLD and other prevalent forms of CRD.
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Affiliation(s)
- Rupert Jones
- Population Studies and Clinical Trials, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Bruce J Kirenga
- Population Studies and Clinical Trials, Makerere Lung Institute, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda
| | - Wincelsas Katagira
- Population Studies and Clinical Trials, Makerere Lung Institute, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda
| | - Sally J Singh
- Cardio-Respiratory Directorate, University Hospitals of Leicester NHS Trust, Leicester
| | - Jill Pooler
- Population Studies and Clinical Trials, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Alphonse Okwera
- Population Studies and Clinical Trials, Makerere Lung Institute, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda
| | - Richard Kasiita
- Department of Physiotherapy, Mulago Hospital, Kampala, Uganda
| | - Doyo G Enki
- Medical Statistics, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Siobhan Creanor
- Medical Statistics, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Andy Barton
- Population Studies and Clinical Trials, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
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Thomas KS, Baier R, Kosar C, Ogarek J, Trepman A, Mor V. Individualized Music Program is Associated with Improved Outcomes for U.S. Nursing Home Residents with Dementia. Am J Geriatr Psychiatry 2017; 25:931-938. [PMID: 28483436 PMCID: PMC5563268 DOI: 10.1016/j.jagp.2017.04.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The objective of this study was to compare resident outcomes before and after implementation of an individualized music program, MUSIC & MEMORY (M&M), designed to address the behavioral and psychological symptoms associated with dementia (BPSD). SETTING 98 nursing homes trained in the M&M program during 2013 and 98 matched-pair comparisons. PARTICIPANTS Long-stay residents with Alzheimer's disease and related dementias (ADRD) residing in M&M participating facilities (N = 12,905) and comparison facilities (N = 12,811) during 2012-2013. INTERVENTION M&M is a facility-level quality improvement program that provides residents with music specific to their personal histories and preferences. MEASUREMENTS Discontinuation of anxiolytic and antipsychotic medications, and reductions in behavioral problems and depressed mood in 2012 (pre-intervention) and 2013 (intervention), calculated using Minimum Data Set (MDS) assessments. RESULTS The proportion of residents who discontinued antipsychotic medication use over a 6-month period increased from 17.6% to 20.1% among M&M facilities, while remaining stable among comparison facilities (15.9% to 15.2%). The same trend was observed for anxiolytic medications: Discontinuation of anxiolytics increased in M&M facilities (23.5% to 24.4%), while decreasing among comparison facilities (24.8% to 20.0%). M&M facilities also demonstrated increased rates of reduction in behavioral problems (50.9% to 56.5%) versus comparison facilities (55.8% to 55.9%). No differences were observed for depressed mood. CONCLUSIONS These results offer the first evidence that the M&M individualized music program is associated with reductions in antipsychotic medication use, anxiolytic medication use, and BPSD symptoms among long-stay nursing home residents with ADRD.
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Affiliation(s)
- Kali S Thomas
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI; Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI; Providence Veterans Affairs Medical Center, Providence, RI.
| | - Rosa Baier
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI; Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI
| | - Cyrus Kosar
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI
| | - Jessica Ogarek
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI
| | - Alissa Trepman
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI
| | - Vincent Mor
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI; Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI; Providence Veterans Affairs Medical Center, Providence, RI
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Morhardt DJ, O'Hara MC, Zachrich K, Wieneke C, Rogalski EJ. Development of a Psycho-Educational Support Program for Individuals with Primary Progressive Aphasia and their Care-Partners. Dementia (London) 2017; 18:1310-1327. [PMID: 29149795 DOI: 10.1177/1471301217699675] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Primary progressive aphasia is a language-based dementia that initially spares other cognitive domains; however, aphasia interferes with many life roles such as work and interpersonal relationships. Psycho-educational programs, such as support groups have been shown to be effective for persons with Alzheimer's dementia; however, little is known regarding their effectiveness for persons with primary progressive aphasia. This paper describes the development of a program that offers support, education and activities for persons with primary progressive aphasia and their care-partners and its feasibility. Development and structure of pilot and formal intervention groups are described. Thematic analysis of both groups included the following themes: (1) coping with limitations and language decline; (2) dealing with increased dependency; (3) expressing resilience and making adaptations; (4) experiencing stigma (pilot group) and confronting stigma (intervention group); (5) experiencing self-confidence; and (6) feeling a sense of belonging. The knowledge gained from this process may be useful in designing programs for individuals with aphasic dementia and preserved insight. Evidence-based data from supportive interventions for persons with primary progressive aphasia and their care-partners are needed.
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Affiliation(s)
- Darby J Morhardt
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, USA
| | - Mary C O'Hara
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, USA
| | - Kristine Zachrich
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, USA
| | - Christina Wieneke
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, USA
| | - Emily J Rogalski
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, USA
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Jafari H, Jannati Y, Nesheli HM, Hassanpour S. Effects of nonpharmacological interventions on reducing fatigue after hematopoietic stem cell transplantation. J Res Med Sci 2017; 22:13. [PMID: 28458705 PMCID: PMC5367206 DOI: 10.4103/1735-1995.199094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 10/02/2016] [Accepted: 10/31/2016] [Indexed: 01/22/2023]
Abstract
Fatigue is one of the main complaints of patients undergoing allogeneic and autologous hematopoietic stem cell transplantation (HSCT). Since nonpharmacological interventions are cost-effective and causes fewer complications, this study aimed to review the studies performed on the effects of nonpharmacological interventions on fatigue in patients undergoing HSCT during September 2016. MEDLINE, CINAHL, Scientific Information Database, IranMedex, PubMed, ScienceDirect, Scopus, Magiran, and IRANDOC databases were searched using Persian and English keywords. A total of 1217 articles were retrieved, 21 of which were used in this study. Exercise is known as an effective intervention in alleviating physical and mental problems of patients undergoing stem cell transplant. This review-based study showed that nonpharmacological methods such as exercise might be effective in decreasing fatigue in patients undergoing stem cell transplant. There is a multitude of studies on some of the complementary and alternative therapy methods, such as music therapy, yoga, relaxation, and therapeutic massage. These studies demonstrated the positive effects of the aforementioned therapies on reduction of fatigue in patients undergoing stem cell transplantation. All the investigated methods in this study were nonaggressive, safe, and cost-effective and could be used along with common treatments or even as an alternative for pharmacological treatments for the reduction, or elimination of fatigue in patients undergoing stem cell transplantation. Given the advantages of complementary and alternative medicine, conducting further studies on this issue is recommended to reduce fatigue in patients after stem cell transplantation.
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Affiliation(s)
- Hedayat Jafari
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Traditional and Complementary Medicine Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Yadollah Jannati
- Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hassan Mahmoodi Nesheli
- Noncommunicable Pediatric Diseases Research Center, Amirkola Children's Hospital, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Somayeh Hassanpour
- Department of Critical Care Nursing, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
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Kolanowski A, Fick D, Litaker M, Mulhall P, Clare L, Hill N, Mogle J, Boustani M, Gill D, Yevchak-Sillner A. Effect of Cognitively Stimulating Activities on Symptom Management of Delirium Superimposed on Dementia: A Randomized Controlled Trial. J Am Geriatr Soc 2016; 64:2424-2432. [PMID: 27861718 DOI: 10.1111/jgs.14511] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether cognitively stimulating activities would reduce duration and severity of delirium and improve cognitive and physical function to a greater extent than usual care. DESIGN Single-blind randomized clinical trial. SETTING Eight post-acute care (PAC) facilities. PARTICIPANTS Community-dwelling older adults with dementia and delirium (N = 283). INTERVENTION Research staff provided cognitively stimulating activities daily for up to 30 days. MEASUREMENTS Primary outcomes were delirium duration (Confusion Assessment Method) and delirium severity (Delirium Rating Scale). Secondary outcomes were cognitive function (Digits Forward, Montreal Cognitive Assessment, CLOX) and physical function (Barthel Index). RESULTS Mean percentage of delirium-free days (intervention: 64.8%, 95% confidence interval (CI) = 59.6-70.1; control: 68.7%, 95% CI = 63.9-73.6; P = .37, Wilcoxon rank sum test) and delirium severity (range 0-39: intervention: 10.77, 95% CI = 10.10-11.45; control: 11.15, 95% CI = 10.50-11.80; difference 0.37, 95% CI = 0.56-1.31, P = .43) were similar in both groups. Significant differences for secondary outcomes favoring intervention were found (executive function (range 0-15): intervention: 6.58, 95% CI = 6.12-7.04; control: 5.89, 95% CI = 5.45-6.33; difference -0.69, 95% CI = 1.33 to -0.06, P = .03; constructional praxis (range 0-15): intervention: 8.84, 95% CI = 8.83-9.34; control: 7.53, 95% CI = 7.04-8.01; difference -1.31, 95% CI = 2.01 to -0.61, P < .001). After adjusting for baseline constructional praxis, the group comparison was no longer significant. Average length of stay was shorter in the intervention (36.09 days) than the control (53.13 days) group (standard error = 0.15, P = .01, negative binomial regression). CONCLUSION Cognitively stimulating activities did not improve delirium but improved executive function and reduced length of stay. Resolution of delirium may require more-intense nonpharmacological management when the individual has dementia.
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Affiliation(s)
- Ann Kolanowski
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania
| | - Donna Fick
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania
| | - Mark Litaker
- School of Dentistry, University of Alabama, Birmingham, Alabama
| | - Paula Mulhall
- Prevention Research Center, College of Health and Human Development, Pennsylvania State University, University Park, Pennsylvania
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, Washington Singer Laboratories, Exeter, United Kingdom
| | - Nikki Hill
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania
| | - Jacqueline Mogle
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania
| | - Malaz Boustani
- School of Medicine and Aging Brain Center, Indiana University, Indianapolis, Indiana
| | - David Gill
- Rochester Regional Health, University of Rochester, Rochester, New York.,Department of Neurology, University of Rochester, Rochester, New York
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Abstract
Dealing with the behavioral and psychological symptoms of dementia (BPSD) is often complex. Given the controversy with regard to antipsychotics for behavioral problems in people with dementia, there has been a renewed emphasis on nonpharmacological interventions, with progress in the design of the relevant studies. Potential nonpharmacological interventions for BPSD are: cognitive training/stimulation, rehabilitative care, activities of daily living, music therapy, massage/touch, physical activity, education/training of professionals, and education and psychosocial support of informal caregivers. Use of antipsychotics in the management of BPSD is controversial due to limited efficacy and the risk of serious adverse effects, but credible alternatives remain scarce. The problem of chronic use of antipsychotics in nursing homes should be tackled. Discontinuation of antipsychotic medication in older individuals with BPSD appears to be feasible. Discontinuation efforts are needed to differentiate between patients for whom antipsychotics have no added value and patients for whom the benefits outweigh the risks.
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Affiliation(s)
- Majda Azermai
- Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
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Brown NJ, David M, Cuttle L, Kimble RM, Rodger S, Higashi H. Cost-Effectiveness of a Nonpharmacological Intervention in Pediatric Burn Care. Value Health 2015; 18:631-637. [PMID: 26297091 DOI: 10.1016/j.jval.2015.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 02/28/2015] [Accepted: 04/03/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To report the cost-effectiveness of a tailored handheld computerized procedural preparation and distraction intervention (Ditto) used during pediatric burn wound care in comparison to standard practice. METHODS An economic evaluation was performed alongside a randomized controlled trial of 75 children aged 4 to 13 years who presented with a burn to the Royal Children's Hospital, Brisbane, Australia. Participants were randomized to either the Ditto intervention (n = 35) or standard practice (n = 40) to measure the effect of the intervention on days taken for burns to re-epithelialize. Direct medical, direct nonmedical, and indirect cost data during burn re-epithelialization were extracted from the randomized controlled trial data and combined with scar management cost data obtained retrospectively from medical charts. Nonparametric bootstrapping was used to estimate statistical uncertainty in cost and effect differences and cost-effectiveness ratios. RESULTS On average, the Ditto intervention reduced the time to re-epithelialize by 3 days at AU$194 less cost for each patient compared with standard practice. The incremental cost-effectiveness plane showed that 78% of the simulated results were within the more effective and less costly quadrant and 22% were in the more effective and more costly quadrant, suggesting a 78% probability that the Ditto intervention dominates standard practice (i.e., cost-saving). At a willingness-to-pay threshold of AU$120, there is a 95% probability that the Ditto intervention is cost-effective (or cost-saving) against standard care. CONCLUSIONS This economic evaluation showed the Ditto intervention to be highly cost-effective against standard practice at a minimal cost for the significant benefits gained, supporting the implementation of the Ditto intervention during burn wound care.
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Affiliation(s)
- Nadia J Brown
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, The University of Queensland, Royal Children's Hospital, Brisbane, Australia.
| | - Michael David
- Queensland Children's Medical Research Institute, The University of Queensland, Royal Children's Hospital, Brisbane, Australia; School of Population Health, The University of Queensland, Brisbane, Australia
| | - Leila Cuttle
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, The University of Queensland, Royal Children's Hospital, Brisbane, Australia; Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, The University of Queensland, Royal Children's Hospital, Brisbane, Australia
| | - Sylvia Rodger
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Hideki Higashi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA
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Hochner H, Tenfelde SM, Abu Ahmad W, Liebergall-Wischnitzer M. Gum chewing and gastrointestinal function following caesarean delivery: a systematic review and meta-analysis. J Clin Nurs 2015; 24:1795-804. [PMID: 25850885 DOI: 10.1111/jocn.12836] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2015] [Indexed: 01/06/2023]
Abstract
AIMS AND OBJECTIVES The aims of this systematic review and meta-analysis were to summarise current knowledge regarding gum chewing intervention for activation of the gastrointestinal (GI) system following caesarean delivery. BACKGROUND GI symptoms such as nausea, vomiting and defecatory difficulties are bothersome for women following a caesarean delivery. There is category A recommendation to not withhold oral intake postoperatively. However, current practice guidelines vary widely on time to initiate oral feeding post caesarean delivery, and additional research is needed. Gum chewing has been shown to stimulate the GI system in other postoperative patient populations. DESIGN A systematic review and meta-analysis. METHODS An electronic review was undertaken using the following resources: PubMed (Medline), CINAHL, EMBASE and ClinicalTrials.gov databases. Key words used in various combinations included cesarean section; cesarean delivery; postoperative chewing gum; bowel movement; bowel function and complications. RESULTS A total of 171 articles were found of which 166 were excluded: 157 were duplicates and the remainder did not meet the inclusion criteria. Five randomised control trials were included in the meta-analysis, focusing on gum chewing as an intervention as compared with a nongum chewing intervention, with a total of 846 participants. Compared with the nongum chewing group, gum chewing showed a beneficial impact on the major outcomes of digestive system activation, including bowel sound, gas passage and defecation. CONCLUSIONS This meta-analysis supports the effectiveness of gum chewing post caesarean delivery as a noninvasive/nonpharmacological intervention for reactivation of bowel movement. RELEVANCE TO CLINICAL PRACTICE Gum chewing in the immediate postoperative period following caesarean delivery may provide a socially acceptable, low-cost and safe intervention to reduce postcaesarean delivery GI complications and restore GI function.
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Affiliation(s)
- Hagit Hochner
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | - Sandi M Tenfelde
- Marcella Niehoff School of Nursing, Loyola University, Chicago, IL, USA
| | - Wiessam Abu Ahmad
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
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Gonzalez MT, Kirkevold M. Benefits of sensory garden and horticultural activities in dementia care: a modified scoping review. J Clin Nurs 2013; 23:2698-715. [PMID: 24128125 DOI: 10.1111/jocn.12388] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2013] [Indexed: 01/03/2023]
Abstract
AIMS AND OBJECTIVES To provide a review on the benefits associated with the use of sensory gardens and horticultural activities in dementia care. BACKGROUND Maintaining quality of life is important in dementia care. Sensory gardens and horticultural activities are increasingly used in dementia care, yet their benefits are uncertain. DESIGN A modified scoping review with descriptive analysis of selected empirical studies. METHODS Systematic searches in Amed, CINAHL, MEDLINE, ISI Web of Science, Embase and Scopus were used. Search terms were the free-text concepts 'healing garden', 'horticultural therapy', 'restorative garden' and 'wander garden' which were combined with dementia and Alzheimer. RESULTS Sixteen studies were included with included participants ranging from eight to 129 participants. Research designs were case studies (n = 2), survey (n = 1), intervention studies with pretest/post-test design (n = 11) and randomised controlled studies (n = 2). Of these 16 studies, eight examined the benefits of sensory gardens, seven examined horticultural therapy or therapeutic horticulture and one examined the use of plants indoors. This study offers a review of the research addressing benefits of sensory gardens, therapeutic horticulture, horticultural therapy and other purposeful use of plants in dementia care. The reported findings are mainly on issues related to behaviour, affect and well-being. The findings are in general mutually supportive, however, with some contradictory findings. In addition, sleep pattern, well-being and functional level seem to improve. CONCLUSIONS These types of nonpharmacological interventions may improve well-being and affect and reduce the occurrence of disruptive behaviour. Additionally, the use of psychotropic drugs, incidents of serious falls, sleep and sleep pattern also seem to improve. RELEVANCE TO CLINICAL PRACTICE To further improve the use of the existing or planned gardens, an educational programme for staff that also includes skill training is recommended.
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Affiliation(s)
- Marianne T Gonzalez
- Institute of Health and Society, University of Oslo, Oslo, Norway; Institute of Nursing and Health, Diakonhjemmet University College, Oslo, Norway
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Abstract
Recent years have seen an expansion of interest in non-pharmacological interventions for attention-deficit/hyperactivity disorder (ADHD). Although considerable treatment development has focused on cognitive training programs, compelling evidence indicates that intense aerobic exercise enhances brain structure and function, and as such, might be beneficial to children with ADHD. This paper reviews evidence for a direct impact of exercise on neural functioning and preliminary evidence that exercise may have positive effects on children with ADHD. At present, data are promising and support the need for further study, but are insufficient to recommend widespread use of such interventions for children with ADHD.
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Cohen-Mansfield J, Marx MS, Freedman LS, Murad H, Thein K, Dakheel-Ali M. What affects pleasure in persons with advanced stage dementia? J Psychiatr Res 2012; 46:402-6. [PMID: 22208995 PMCID: PMC3288263 DOI: 10.1016/j.jpsychires.2011.12.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 10/31/2011] [Accepted: 12/02/2011] [Indexed: 11/25/2022]
Abstract
We examined the impact of environmental, person, and stimulus characteristics on pleasure in persons with dementia. Study participants were 193 residents of 7 Maryland nursing homes who were presented with 25 stimuli from these categories: live human social stimuli, live pet social stimuli, simulated social stimuli, inanimate social stimuli, a reading stimulus, manipulative stimuli, a music stimulus, task and work-related stimuli, and two different self-identity stimuli. Systematic observations of pleasure in the natural environment were conducted using Lawton's Modified Behavior Stream. Analysis showed that pleasure is related to stimulus category, personal attributes and environmental conditions. In the multivariate analyses, all types of social stimuli (live and simulated, human and nonhuman), self-identity stimuli, and music were related to significantly higher levels of pleasure than the control condition. Females and persons with higher ADL and communication functional status exhibited more pleasure. Pleasure was most likely to occur in environments with moderate noise levels. These results demonstrate that these nursing home residents are indeed capable of showing pleasure. Caregivers of nursing home residents with dementia should incorporate social, self-identity, and music stimuli into their residents' care plans so that eliciting pleasure from each resident becomes the norm rather than a random occurrence.
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Affiliation(s)
| | | | | | - Havi Murad
- Gertner Institute for Epidemiology and Health Policy Research, Israel
| | - Khin Thein
- Innovative Aging Research, Silver Spring, MD
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Howe E. Using nonevidence-based approaches to treat patients with alzheimer's disease. Psychiatry (Edgmont) 2009; 6:18-23. [PMID: 19724750 PMCID: PMC2719455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In this article, the author discusses the rationale behind offering patients with Alzheimer's disease treatments that are not strongly evidence based. The author will discuss specific nonevidence-based (or not strongly evidence-based) interventions psychiatrists may consider offering their patients with AD, including nonpharmacological and pharmacological approaches. The author will also discuss positive and negative aspects of these interventions and suggest some steps psychiatrists can take to try to avoid the potential downsides.
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Affiliation(s)
- Edmund Howe
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
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