Music interventions for psychological and physical outcomes in cancer: a systematic review and meta-analysis

Purpose

A systematic review and meta-analysis to examine the effect of music interventions on psychological and physical outcome measures in cancer patients.

Methods

We searched six English-language databases and three major Chinese-language databases in March 2011. Nine databases were reviewed from 1966 or the start of the database to March 2011. All randomized controlled trials comparing music intervention with standard care, other interventions, or placebo for psychological and physical outcomes in cancer were included. Study quality was evaluated by the Grading of Recommendations Assessment, Development, and Evaluation Working Group. We then performed a meta-analysis of music interventions for psychological and physical outcomes in cancer.

Results

Of 322 total studies found, 32 randomized trials (3181 participants) met the inclusion criteria. Seven high-quality studies indicated music had positive effects on coping anxiety assessed by the Self-Rating Anxiety Scale. Two moderate-quality studies suggested music reduced anxiety assessed by the Hamilton Anxiety Scale. Eight moderate-quality studies revealed music lowered anxiety assessed by the Spielberger State-Trait Anxiety Inventory. Seven moderate-quality studies demonstrated that music improved depression. Seven moderate-quality studies observed that music had positive effects on pain management. Two moderate-quality studies suggested music worsened fatigue. Four moderate-quality studies indicated music lowered heart rate. Three low-quality studies suggested music could reduce respiratory rate. Two moderate-quality studies indicated that music improved quality of life.

Conclusions

Individual randomized trials suggest that music intervention is accepted by patients and associated with improved psychological outcomes. The effects of music on vital signs especially blood pressure are small. High-quality trials are needed to further determine the effects of music intervention.     

Competing and conflicting interests in the care of critically ill patients

Medical professionals are expected to prioritize patient interests, and most patients trust physicians to act in their best interest. However, a single patient is never a physician’s sole concern. The competing interests of other patients, clinicians, family members, hospital administrators, regulators, insurers, and trainees are omnipresent. While prioritizing patient interests is always a struggle, it is especially challenging and important in the ICU setting where most patients lack the ability to advocate for themselves or seek alternative sources of care. This review explores factors that increase the risk, or the perception, that an ICU physician will reason, recommend, or act in a way that is not in their patient’s best interest and discusses steps that could help minimize the impact of these factors on patient care.     

Perioperative data elements: interventions and outcomes

In 1999, the American Nurses Association's committee on nursing practice recognized AORN's Perioperative Nursing Data Set (PNDS) as a data set useful in the practice of nursing. The PNDS is a standardized nursing language specific to perioperative settings that is both clinically relevant and empirically validated. This data set is the culmination of six years of effort by AORN and AORN staff members to develop a standardized language that is clearly defined, common to all cases, and consistent across time.     

Nursing outcomes: percutaneous coronary interventions

Percutaneous coronary interventional (PCI) procedures are commonly performed in the United States. The process of caring for this patient population has changed dramatically over the last 10 years, with many of the changes being driven by an evolution in the knowledge base underlying nursing practice. The purpose of this article is to provide a summary and critique of nurse-sensitive outcomes related to patients undergoing PCI procedures and to identify gaps in the literature to provide recommendations for future research. Nursing research on indicators related to costs of care, morbidity, symptom management, functional status, patient/family knowledge, patient responses, behavior, and home/occupational function following PCI are discussed in this review.     

Antimicrobial stewardship programs: interventions and associated outcomes

Guidelines regarding antimicrobial stewardship programs recommend an infectious diseases-trained physician and an infectious diseases-trained pharmacist as core members. Inclusion of clinical microbiologists, infection-control practitioners, information systems experts and hospital epidemiologists is considered optimal. Recommended stewardship interventions include prospective audit and intervention, formulary restriction, education, guideline development, clinical pathway development, antimicrobial order forms and the de-escalation of therapy. The primary outcome associated with these interventions has been the associated cost savings; however, few published investigations have taken into account the overall cost of the intervention. Over the past 5 years, there has been an increased focus upon interventions intended to decrease bacterial resistance or reduce superinfection, including infections associated with Clostridium difficile colitis. Few programs have been associated with a reduction in antimicrobial drug adverse events. Antimicrobial stewardship programs are becoming increasingly associated with clear benefits and will be integral in the in-patient healthcare setting.     

Anticipatory nausea and vomiting: A review of psychological interventions

Although a cure for cancer continues to elude scientists, modern chemotherapy treatments can typically reduce or reverse the rate of disease progression and can often lead to restored health. However, chemotherapy can also produce severe, sometimes intolerable, side effects. A particularly distressing and aversive side effect that develops in 25 to 32% of all chemotherapy patients is anticipatory nausea and vomiting (ANV). Fortunately, research investigating the prevalence, etiology, predictors, and treatment of ANV has flourished since the early 1980s, and there has been significant progress in understanding this phenomenon. Although antiemetic medications appear to be ineffective in controlling ANV, several psychological interventions, including progressive muscle relaxation training, systematic desensitization, hypnosis, attentional distraction, and stimulus control have produced promising results. The present paper is a review of these interventions.     

Acute lymphoblastic leukemia: long-term psychological outcome

Children diagnosed with acute lymphoblastic leukemia (ALL) now have an excellent chance for a medical cure. Nearly 90% can expect to attain an initial remission and the majority of those will remain disease-free. There is increasing concern about the long-term consequences of ALL and its treatment on the psychological adjustment of the survivor. This article selectively reviews the available literature on the neuropsychological and psychosocial adjustment of long-term survivors of ALL. The risk of neuropsychologic deficiencies among children who have remained in continuous remission has been the focus of conflicting findings, while the risk among those who have survived CNS relapse is clearly elevated. Generally, long-term survivors of childhood cancer have a 30-40% risk of school-related problems. Moreover, children treated for ALL with cranial irradiation have 3-4 times the risk of school problems relative to those who are not irradiated. Early identification of problems would facilitate referrals for appropriate intervention and hopefully minimize future difficulties.     

Evidence for interventions to improve psychological outcomes in people with head and neck cancer: a systematic review of the literature

Purpose  

In addition to cancer-related distress, people with head and neck cancer (HNC) endure facial disfigurement and difficulties with eating and communication. High rates of alcohol use and socio-economic disadvantage raise concerns that patients with HNC may be less likely than others to participate in and adhere to psychological interventions. This article aims to inform future practice and research by reviewing the evidence in support of psychological interventions for this patient group.     

体感诱发电位监测不同介入方法治疗腰椎间盘突出症近远期疗效比较

目的:采用体感诱发电位监测和量化评估激光椎间盘减压术与传统的胶原酶溶核术治疗腰椎间盘突出症的疗效,并做1个月和1年的近远期差异分析。方法:2000-10/2003-04暨南大学医学院第二临床学院脊柱外科收治的符合微创介入治疗适应证的腰椎间盘突出症患者93例,经患者同意,采用随机数字表法分为激光椎间盘减压术组47例和胶原酶溶核术组46例。激光椎间盘减压术组采用激光椎间盘减压术介入治疗,Nd:YAG连续型激光,波长1064nm;胶原酶溶核术组采用胶原酶溶核术治疗,将胶原蛋白溶解酶1200U溶于5mL生理盐水中,缓慢注入。两组患者在治疗前检查记录症状、体征和进行皮节体感诱发电位检查数据,在治疗后1周、1个月、6个月、1年对患者进行随访,复查患者症状、体征和皮节体感诱发电位结果。根据患者症状、体征恢复程度、影像学检查结果和诱发电位表现形式作为评估标准,以优良率作为疗效指标,选择术后1个月和1年为早期和远期疗效评定时间点。结果:术后1个月时,激光椎间盘减压术组47例中有1例失访,胶原酶溶核术组46例中有2例失访,90例患者进入结果分析,至1年随访时,仍为90例。①术后1个月时两组的优良率评分基本一致[(71%(33/46)和66%(29/44),(χ2=0.357,P=0.550)],术后1年时激光椎间盘减压术组治疗优良率显著高于胶原酶溶核术组[85%(39/46),(66%,29/44),(χ2=4.337,P=0.037)]。②术后1个月随访,两组体感诱发电位潜伏期和波幅变化相似,术后1年时,激光椎间盘减压术者的潜伏期缩短和波幅升高与胶原酶溶核术组比较均有显著差异。结论:激光椎间盘减压术与胶原酶溶核术两种方法均能不同程度提高腰椎间盘突出症患者的疗效,近期疗效两种方法相似,术后1年远期随访时激光椎间盘减压治疗技术效果较好。     

The context, measures and outcomes of psychosocial care interventions in long-term health care for older people

This paper examines the psychosocial dimensions of long-term care with reference to the new International Classification of Functioning, Disability and Handicap (ICIDH 2) and to research conducted in Hong Kong. It also draws on selected international literature about older people. It discusses the different ways in which information can be gained about the personal, social and emotional processes of rehabilitation that influence outcomes and raises methodological questions about the study of interventions. Outcomes that are sensitive to psychosocial interventions and that take account of the elderly person's own perspective are identified as important challenges for nurses and other professionals in the multidisciplinary team, in order to respond to an individualized approach to long-term care. It is concluded that gaining a better understanding of the psychosocial dimensions of long-term care will enhance professional practice and benefit older people and their carers.     

Neonatal seizures: diagnosis, pharmacologic interventions, and outcomes

Neonatal seizures are difficult to detect, diagnose, and manage. Infants with a history of seizures often have long-term neurologic sequelae. Controversy exists as to whether neonatal seizures themselves cause damage to the developing brain, and thus, subsequent sequelae; or if these sequelae are due primarily to the underlying cause of the seizures. Treatment of seizures involves identifying and treating the underlying etiology of the seizure and appropriate use of pharmacologic interventions. To provide the context for pharmacological management of seizures in newborns, this article examines the pathophysiology and etiology of seizures and discusses pharmacological agents and issues, short- and long-term outcomes, clinical implications, and directions for future research. Understanding pharmacological issues within this context provides a comprehensive foundation for decision making and management of neonatal seizures.     

Nursing interventions and patient outcomes: a meta-analysis of studies

The 84 subject-studies and 4,146 individual subjects in this meta-analysis were obtained from nurse-conducted experimental research over an 8-year period. The entire universe of accessible subject-studies that met criteria was included. Although both published and unpublished research were included to protect the study from publication bias, there was no statistically significant difference in findings. The mean effect size for the sample of comparisons from the 84 studies was .59. The associated U3 value of 72.2 and r of .28 indicate that patients who receive research-based nursing interventions can expect 28% better outcomes than 72% of the patients who receive standard nursing care.     

危机心理干预者面临的过劳现象及其干预

目的:处于危机干预第一线的危机心理干预者,把无数面临危机的人从危险境遇带回安全状态,在其进行人类服务工作的同时,也面临着过劳危机,由于职业的特殊性,对其进行危机干预的方法与一般有所不同。资料来源:应用计算机检索PsycCRITIQUESTM数据库、PsycINFO/PsyARTICLES数据库、Medline数据库1980-01/2005-07期间关于危机心理干预者面临的过劳及干预的文章,检索词“Psychologicalcrisisintervenor,Crisisintervention,burnout”,限定语言种类为英文。同时计算机检索中国期刊全文数据库、万方数据库和《中国临床康复》杂志1990-01/2005-07期间的相关文章,检索词“心理危机干预者、危机干预、过劳”,限定语言种类为中文。同时手工检索相关内容的中外书籍。资料选择:对资料进行初审,选取相关资料,并查找全文,以是否为“心理危机干预者所面临的危机及其干预措施”作为纳入标准。排除重复性研究文献。资料提炼:共收集到45篇关于危机干预者过劳的文章,排除38篇,纳入7篇,并引用2本书籍内容。资料综合:过劳具有多维性,典型过劳易患者的病程分为4个阶段:阶段1-热情;阶段2-停滞;阶段3-失望;阶段4-淡漠。导致过劳的原因有:①不合理的信念;②危机心理干预者工作本身的特殊性;③危机心理干预者和求助者的关系;④组织机构的管理不善;⑤对“过劳”错误的自我认识;⑥危机干预技巧运用不当导致的危机。对过劳的危机心理干预者进行危机干预主要从外部干预和自我干预两个方面着手。结论:过劳是一种可以损害人们身体健康的疾病,通过外部干预(训练干预,组织机构干预、社会支持系统、关键事件应激报告)和自我干预(内部的认知和情绪方面自我调节,间接的“非补偿行为”自我调节),任何人对过劳都没有免疫力,只有通过正确有效的治疗,才能重新获得生产力。     

Elementary school nurse interventions: attendance and health outcomes.

Regular school attendance is a necessary part of the learning process; student absenteeism has a direct association with poor academic performance. School nurses can influence student attendance. This study describes the impact of school nurse interventions on student absenteeism and student health. A retrospective review of 240 randomly selected elementary student health folders and attendance records was conducted. School nurses were involved with 75% of high-absence students as compared to 66% of low-absence students; they were also more involved with students who had previously identified health conditions. There were no referrals to the school nurse for absenteeism and school nurse interventions were not targeted to attendance, despite 17% of students missing 11 or more school days. Nursing documentation was sparse and primarily task related. Few records contained entries of nursing diagnoses, interventions, or outcomes. Of the 134 interventions provided, only 56 (41.2%) had some information about the condition outcome, but it was insufficient to determine the effectiveness of nursing interventions. Furthermore, the record system did not support the collection of standard information for interventions or outcomes from which effectiveness could be determined. Recommendations include establishment of an attendance referral policy and improved documentation systems, including the use of standardized nursing language to demonstrate student outcomes.     

Effects of nonpharmacological delirium-prevention interventions on critically ill patients' clinical,psychological, and family outcomes: A systematic review and meta-analysis

BackgroundDelirium is common in critically ill patients and may lead to severe complications, such as falls and injuries. Nonpharmacological interventions have been widely suggested to prevent delirium, yet the effects remain uncertain.ObjectivesThe aim of the study was to determine the effects of nonpharmacological interventions on preventing delirium and improving critically ill patients' clinical, psychological, and family outcomes.MethodsTen databases were searched from their inception to September 2020. Two reviewers assessed the methodological quality and extracted details of the included studies. The data were narratively or statistically pooled where appropriate. Dichotomous variables are presented as odds ratio (OR), and continuous variables are presented as mean difference (MD). The Grading of Recommendations Assessment, Development, and Evaluation criteria were used to assess the quality of evidence for each review outcome.ResultsThirty-four studies (10 randomised controlled trials, eight controlled clinical trials, and 16 before-and-after studies) were included in the analysis. Low-certainty evidence indicated that nonpharmacological interventions reduced delirium incidence (OR = 0.43, 95% confidence interval [CI] [0.33, 0.55]), delirium duration (MD = ?1.43 days, 95% CI [?1.94, 0.92]), and length of stay in the intensive care unit (MD = ?1.24 days, 95% CI [?2.05, ?0.43]). Moderate-certainty evidence demonstrated no effect on mortality. Narrative synthesis further implied improvements in patients' psychological recovery (two studies, very low-certainty evidence) and families' satisfaction with care (two studies, very low-certainty evidence) through nonpharmacological interventions. As for effective intervention types, moderate-certainty evidence demonstrates that early mobilisation (OR = 0.33, 95% CI [0.24, 0.46], five studies, 859 participants, I² = 24%), family participation (OR = 0.25, 95% CI [0.18, 0.34], four studies, 997 participants, I² = 21%), and use of multicomponent interventions (OR = 0.48, 95% CI [0.34, 0.69], 13 studies, 3172 participants, I² = 77%) are associated with reduced incidence of delirium.ConclusionsHealthcare professionals are recommended to apply early mobilisation, family participation, or multicomponent interventions in clinical practice to prevent delirium. Further studies investigating the effects of nonpharmacological interventions on patients' psychological and family outcomes are warranted.     

Affective distress and implantable cardioverter defibrillators: cases for psychological and behavioral interventions

The implantable cardioverter defibrillator (ICD) may be associated with some degree of psychological maladjustment, especially in patients experiencing high rates of discharge. This article reviews the psychological literature related to ICDs and presents two case examples illustrating common psychological complications related to multiple discharges. A brief, psychological intervention can be implemented to improve patient adjustment. To explain possible processes by which psychological complications may develop in ICD patients, two well-established psychological theories of learning and behavior, classical conditioning and learned helplessness, are reviewed. Multidisciplinary teams that include consultation with clinical psychologists are suggested for the routine care of ICD patients.     

Clinical management of DIC: early nursing interventions

Achievement of successful patient outcomes depends on the availability of a primary nurse responsible for all aspects of nursing care. A consistent caregiver not only has a grasp of phenomena at hand but possesses an overall perspective of recovery. Care can be evaluated and readjusted on a timely basis. Identification of signs of progress as well as deterioration may be facilitated through continuity of care. The primary nurse can provide meaningful, ongoing information to the patient and significant others as a means of optimizing their coping behaviors. Effective nursing care of the patient with DIC is enhanced by a thorough understanding of its pathophysiology and its clinical manifestations. When the critical care nurse has a comprehensive knowledge base and uses purposeful assessment skills, potential complications become much clearer and are avoided. The primary nurse who knows how to prioritize care is capable of anticipating the patient's needs. By integrating theory with practice, the critical care nurse functions from a position of strength in promoting quality patient care.