Home-based music therapy (HBMT) is an innovative service that is being used increasingly for patients who require care at home. A systematic review identified 20 studies on HBMT from several countries. The majority of studies involved elderly patients living at home or those needing hospice/palliative care. While settings varied, music listening programs were most common. Studies found HBMT effective in reducing symptoms like depression and pain and improving quality of life and caregiver relationships. HBMT shows promise as an accessible therapeutic option for those receiving home healthcare.
Homeopathy – what are the active ingredients? An exploratory study using the ...home
This study has has identified, using primary consultation and other data, a range of
factors that might account for the effectiveness of homeopathic care. Some of these, such as
empathy, are non-specific. Others, such as the remedy matching process, are specific to
homeopathy. These findings counsel against the use of placebo-controlled RCT designs in which
both arms would potentially be receiving specific active ingredients. Future research in homeopathy
should focus on pragmatic trials and seek to confirm or refute the therapeutic role of constructs
such as patient "openness", disclosure and homeopathicity.
Can the caged bird sing? Reflections on the application of qualitative resear...home
Two main pathways exist for the development of knowledge in clinical homeopathy.
These comprise clinical trials conducted primarily by university-based researchers and cases
reports and homeopathic "provings" compiled by engaged homeopathic practitioners. In this paper
the relative merits of these methods are examined and a middle way proposed. This consists of the
"Formal Case Study" (FCS) in which qualitative methods are used to increase the rigour and
sophistication with which homeopathic cases are studied. Before going into design issues this paper
places the FCS in an historical and academic context and describes the relative merits of the
method.
The Effectiveness of Music Therapy on Cerebral Palsy Patients Receiving Rehab...inventionjournals
Objective: To find out the effect of music therapy in cerebral palsy (CP) patients between who received conventional rehabilitation treatments and who additionally received music therapy Methods: In this retrospective study, 50 CP patients who received rehabilitation treatments on a day-ward basis for at least six months, between March 2013 and February 2015, were selected as subjects. Of the 50 patients, 25 received only conventional rehabilitation treatment (rehabilitation group), and the remaining 25 received both the conventional rehabilitation treatment and music therapy (music therapy group). In this study, the results of the Korean-version Denver Developmental Screening Test 2 (DDST-2) and the social quotient (SQ) were confirmed, before and after the treatments. Results: At baseline, no statistically significant differences were confirmed between the rehabilitation group and the music therapy group in terms of gender, age, and diagnosis. Korean-version DDST-2 scores and the SQ score also did not show statistically significant differences between the groups. With the intervention, the music therapy group showed more statistically significant improvements in the gross motor, fine motor, language, and personal-social parts than the rehabilitation group. The music therapy group also showed greater improvement in SQ score than the rehabilitation group, but the difference was statistically insignificant. Conclusion: This study was conducted to prove the effectiveness of the current music therapy program and to investigate the area in which the therapy produces the greatest effect. It is hoped that the therapy would find wider application among children in the future as it showed significant functional improvements in the gross motor, fine motor, language, and personal-social parts in this study
Homeopathy – what are the active ingredients? An exploratory study using the ...home
This study has has identified, using primary consultation and other data, a range of
factors that might account for the effectiveness of homeopathic care. Some of these, such as
empathy, are non-specific. Others, such as the remedy matching process, are specific to
homeopathy. These findings counsel against the use of placebo-controlled RCT designs in which
both arms would potentially be receiving specific active ingredients. Future research in homeopathy
should focus on pragmatic trials and seek to confirm or refute the therapeutic role of constructs
such as patient "openness", disclosure and homeopathicity.
Can the caged bird sing? Reflections on the application of qualitative resear...home
Two main pathways exist for the development of knowledge in clinical homeopathy.
These comprise clinical trials conducted primarily by university-based researchers and cases
reports and homeopathic "provings" compiled by engaged homeopathic practitioners. In this paper
the relative merits of these methods are examined and a middle way proposed. This consists of the
"Formal Case Study" (FCS) in which qualitative methods are used to increase the rigour and
sophistication with which homeopathic cases are studied. Before going into design issues this paper
places the FCS in an historical and academic context and describes the relative merits of the
method.
The Effectiveness of Music Therapy on Cerebral Palsy Patients Receiving Rehab...inventionjournals
Objective: To find out the effect of music therapy in cerebral palsy (CP) patients between who received conventional rehabilitation treatments and who additionally received music therapy Methods: In this retrospective study, 50 CP patients who received rehabilitation treatments on a day-ward basis for at least six months, between March 2013 and February 2015, were selected as subjects. Of the 50 patients, 25 received only conventional rehabilitation treatment (rehabilitation group), and the remaining 25 received both the conventional rehabilitation treatment and music therapy (music therapy group). In this study, the results of the Korean-version Denver Developmental Screening Test 2 (DDST-2) and the social quotient (SQ) were confirmed, before and after the treatments. Results: At baseline, no statistically significant differences were confirmed between the rehabilitation group and the music therapy group in terms of gender, age, and diagnosis. Korean-version DDST-2 scores and the SQ score also did not show statistically significant differences between the groups. With the intervention, the music therapy group showed more statistically significant improvements in the gross motor, fine motor, language, and personal-social parts than the rehabilitation group. The music therapy group also showed greater improvement in SQ score than the rehabilitation group, but the difference was statistically insignificant. Conclusion: This study was conducted to prove the effectiveness of the current music therapy program and to investigate the area in which the therapy produces the greatest effect. It is hoped that the therapy would find wider application among children in the future as it showed significant functional improvements in the gross motor, fine motor, language, and personal-social parts in this study
Pediatric Primary Care In Europe. The most appropriate medical professional ...pediatricworld MSN
Pediatricians: The most suitable medical professionals for the role of pediatric primary healthcare In Europe.
Presentation of the results of a Systematic Review comparing the differences in the clinical practice, the quality of the care delivered, and the results of the performance, in primary healthcare for children and adolescents in Europe, between PEDIATRICIANS and GENERAL PRACTITIONERS/FAMILY DOCTORS.
General principles of research methodology. Terms frequently used in this chapter. It is a course subject for fourth Pharm D in The Tamilnadu Dr.MGR. Medical University, Chennai.
Research Methodology In Medical Research. This presentation gives an comprehensive overview of research methodology in biomedical research also includes different types of medical research and ethics in medical research.
Effect of homeopathy on chronic tension-type headache: a pragmatic, randomise...home
Homeopathy is increasingly used by headache patients in
general practice but scientific evidence is lacking. We
therefore designed a clinical trial in a way that would not
change the practice pattern of homeopathic physicians.
Homeopathy for allergic rhinitis: protocol for a systematic reviewhome
This will be the first systematic review of all types of
homeopathy for allergic rhinitis. We have attempted to
design a robust protocol which should result in an objective
and adequate summary of the available evidence
in this area of research. The review is not limited to
studies published in the English language: such limitation
might have excluded several studies that met all
other inclusion criteria. The selected databases index a
large number of CAM journals and the search strategy
is expected to identify most of the relevant studies that
exist.
Pediatric Primary Care In Europe. The most appropriate medical professional ...pediatricworld MSN
Pediatricians: The most suitable medical professionals for the role of pediatric primary healthcare In Europe.
Presentation of the results of a Systematic Review comparing the differences in the clinical practice, the quality of the care delivered, and the results of the performance, in primary healthcare for children and adolescents in Europe, between PEDIATRICIANS and GENERAL PRACTITIONERS/FAMILY DOCTORS.
General principles of research methodology. Terms frequently used in this chapter. It is a course subject for fourth Pharm D in The Tamilnadu Dr.MGR. Medical University, Chennai.
Research Methodology In Medical Research. This presentation gives an comprehensive overview of research methodology in biomedical research also includes different types of medical research and ethics in medical research.
Effect of homeopathy on chronic tension-type headache: a pragmatic, randomise...home
Homeopathy is increasingly used by headache patients in
general practice but scientific evidence is lacking. We
therefore designed a clinical trial in a way that would not
change the practice pattern of homeopathic physicians.
Homeopathy for allergic rhinitis: protocol for a systematic reviewhome
This will be the first systematic review of all types of
homeopathy for allergic rhinitis. We have attempted to
design a robust protocol which should result in an objective
and adequate summary of the available evidence
in this area of research. The review is not limited to
studies published in the English language: such limitation
might have excluded several studies that met all
other inclusion criteria. The selected databases index a
large number of CAM journals and the search strategy
is expected to identify most of the relevant studies that
exist.
Music therapy in paediatric and adolescent cancer patients a scoping reviewJavier González de Dios
La musicoterapia consiste en usar las respuestas y conexiones de una persona con la música para estimular cambios positivos en el estado de ánimo y el bienestar general. Puede ayudar a mejorar la confianza en uno mismo, la comunicación, la independencia, la autoconciencia y la conciencia de los demás y la capacidad de concentración y atención.
La terapia musical puede incluir crear música con instrumentos de todo tipo, cantar, moverse con la música o simplemente escucharla. La interacción musical entre una persona y su terapeuta es importante durante la terapia musical. La improvisación también pueden ser una parte clave de la terapia musical; esto consiste en hacer música en el momento, respondiendo a un estado de ánimo o a un tema.
El uso de la música para terapia y curación se hunde en la historia de la humanidad, aunque es prevalente en la Antigua Grecia, y su uso terapéutico actual empezó a ser consistente en el siglo XX, después de que terminara la Segunda Guerra Mundial. La referencia más antigua a la terapia musical viene de un artículo de 1789 titulado “Consideración física de la música”. En el siglo XIX devino el crecimiento de la investigación médica sobre la capacidad terapéutica de la música, y desde 1940 las universidades empezaron a ofrecer programas de terapia musical. Ahora, existen muchas asociaciones de musicoterapia en todo el mundo y los terapeutas musicales trabajan en consultorios privados, escuelas, centros de atención social y también en centros sanitarios, como es el caso que nos convoca.
Porque hoy os presentamos uno de los artículos generados en la Tesis doctoral que el Dr. Román Rodríguez está desarrollando en nuestro Servicio de Pediatría, bajo el título de “ “ y cuyo objetivo es el de estudiar el valor de la música en los niños y adolescentes con cáncer, en sus familias y también en los propios profesionales sanitarios,
Y en este artículo que compartimos en este enlace y debajo, se realiza una revisión (scoping review) del valor de la musicoterapia en niños y adolescentes con cáncer.
Patient satisfaction and side effects in primary care: An observational study...home
Overall patient satisfaction was significantly higher in homeopathic than in
conventional care. Homeopathic treatments were perceived as a low-risk therapy with two to
three times fewer side effects than conventional care
Patient satisfaction and side effects in primary care: An observational study...home
Overall patient satisfaction was significantly higher in homeopathic than in
conventional care. Homeopathic treatments were perceived as a low-risk therapy with two to
three times fewer side effects than conventional care
Music has a dynamic effect on the mind and the body. Music therapy is an established method of managing certain ailments of the disease. I presented the scientific data about the history and development of music therapy. This entity require research and meta analysis so that it will establish it's course of study and evaluate it's individual role in the management of a disease.
Lesson 7 Adult Mental Health ServicesReadings Department of.docxSHIVA101531
Lesson 7: Adult Mental Health Services
Readings:
Department of Health and Human Services (1999). Surgeon General’s Report on Mental Health, Chapter 4 http://mentalhealth.about.com/cs/comprehensivesites/l/blsgc4s1.htm
Greenberg, G.A. & Rosenheck, R.A. (2008). Jail Incarceration, homelessness, and mental health: A National Study. Psychiatric Services 59(2), 170-177
Watson, A., Hanrahan, P., Luchins, D., & Lurigio, A. (2001). Mental health courts and the complex issues of mentally ill offenders. Psychiatric Services, 52, 477-481
Frontline (May 14, 2005). The New Asylums. http://www.pbs.org/wgbh/pages/frontline/shows/asylums/view/
New York Times (July 30, 2015). A psychologist as warden? Jail and mental illness intersection in Chicago. http://www.nytimes.com/2015/07/31/us/a-psychologist-as-warden-jail-and-mental-illness-intersect-in-chicago.html?_r=0.
Watch “The Released" (PBS) http://video.pbs.org/video/1114528522/
Scan:
President’s New Freedom Commission on Mental Health Executive Summary. http://store.samhsa.gov/shin/content//SMA03-3831/SMA03-3831.pdf
SAMHSA: Leading Change 2.0: Advancing the Behavioral Health of the Nation, 2015-2018. http://store.samhsa.gov/product/Leading-Change-2-0-Advancing-the-Behavioral-Health-of-the-Nation-2015-2018/PEP14-LEADCHANGE2
Introduction
This week the topic is adult mental health care. Although many attempts have been made over the years to create a coherent policy and a system of care for adults, these outcomes have been elusive. Although community programs were designed to address the abuses found in large institutions, deinstitutionalization did not live up to the promises for better treatment and services.
Deinstitutionalization
The issue of deinstitutionalization was briefly addressed in Lesson 2. A short refresher of historical developments leading up to deinstitutionalization, however, may be helpful.
Treatment options for persons with mental illness grew in the twentieth century as we began to apply new knowledge and treatments. In addition to somatic treatments such as electroshock therapy and psychosurgery developed during the 1930’s and 1940’s, the use of psychodynamic methods became better known after World War II. At the same time that psychodynamic orientation became more widely used, there was increasing interest in the impact of environment on mental disorders. The pioneer in this area was psychiatrist Harry Stack Sullivan. In fact, Grob (1991) credits Sullivan as the primary person who “paved the way for the collaboration of psychiatry and social science, and thus facilitated the emergence of socially oriented therapies . . .” after the war (p.140).
While Grob states that psychopharmacology was “virtually nonexistent” immediately following the war, this science made tremendous advances in a very short period during the late 1940’s and early 1950’s. During this time, clinical trials were conducted showing the results of the use of chlorpromazine, the first drug wi ...
Objective: The purpose of this paper is to review literature on music and biomarkers of stress in order to (1) Identify music interventions and (2) Detail the biomarkers of stress associated with music. Methods: PRISMA guidelines were followed in performing this systematic review. Studies published from January 1995 to January 2020 that pertain to biomarkers of stress and music were identified through the use of the PubMed database, using the keywords: ‘music’ AND ‘biomarker’ OR ‘marker’ OR ‘hormone’. Two authors independently conducted a focused analysis and reached a final consensus on 16 studies that met the specific selection criteria and passed the study quality checks. Results: The reviewed studies were all randomized controlled trials. Reviewed music interventions included Music Listening (ML), Meditational Music (MM), ‘Guided Imagery and Music’ (GIM), and Singing. The studies showed that music is associated with a decreasing trend in cortisol, salivary α-amylase, heart rate, and blood pressure, as well as an increasing trend in Immunoglobulin A (IgA), oxytocin, and EEG theta wave, while testosterone was associated with sex-related differences. Conclusion: Music is associated with significant changes in biomarkers of stress, suggesting that it could be utilized for the development of stress reduction tools.
A Model of Integrated Primary Care: Anthroposophic Medicine ~ National Centre for Social Research
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The value of music therapy in the expression of emotions in children with cancerJavier González de Dios
Con respecto al proyecto de tesis que llevamos desarrollando en los últimos años en nuestro Servicio de Pediatría en relación con el valor de la musicoterapia en los pacientes pediátricos oncológicos, en sus familias y en los propios profesionales sanitarios que los atienden, hoy compartimos este artículo “The value of music therapy in the expression of emotions in children with cáncer” publicado en European Jounal of Cancer Care.
Os dejamos el artículo completo para su lectura, pero incluimos el resumen del mismo:
“Background. Children with cancer are subjected to aggressive tests and treatments that can affect their emotional states. Studies available in the academic literature analyse the effect of music therapy on the emotions of these patients are scarce.
Objectives. The objective of this study was to explore and transform the emotional responses that may arise with the application of music therapy (MT) in children with oncological pathology.
Methods. The methodology of this study was based on the participatory action research approach. Semistructured interviews were conducted with 27 children with cancer who participated in 65MT sessions. Interviews were also conducted with their families.
Results. We conducted a thematic analysis using MAXQDA software. Three main categories emerged from this process as follows: (1) expression: children with cancer stated that MT made it easier for them to express their emotions, with indirect benefits to families; (2) participation: patients showed interest in the sessions; and (3) experiences: MT was valued and created a positive environment. The results of this research demonstrate the positive transformative power MT had on children with cancer in terms of their emotions.
Conclusions. Positive results were achieved through MT that encouraged the expression of emotions by children with cancer and favoured and improved their moods. In addition, it also encouraged social interactions in the hospital and helped the children to better cope with their illness through self-awareness. Their families also benefited. Therefore, we encourage healthcare professionals to support the use of MT in paediatric oncology settings”.
The pharmaceutical industry has made it very difficult to know what the clinical trial evidence actually is regarding psychotropics. Consequently, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence based prescriptive practice. This article calls for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. The authors assert that current prescribing practices are empirically unsound and unduly influenced by pharmaceutical company interests, resulting in unnecessary risks to patients. In the spirit of evidenced based medicine’s inclusion of patient values as well as the movement toward health home, we present a patient bill of rights for psychotropic prescription. We then offer guidelines to raise the bar of care equal to the available science for all prescribers of psychiatric medications.
Background: Behavioral health conditions are prevalent among patients in inpatient medical settings and when not adequately treated contribute to diminished treatment outcomes and quality of life. Substantial evidence has demonstrated the effectiveness of psychological interventions in addressing behavioral health conditions in a range of settings but, to a lesser extent with psychologically-based interventions delivered in inpatient medical settings. Purpose: The purpose of this paper is to increase attention on psychological interventions being delivered to patients across a broad spectrum of medical specialties in inpatient medical settings to support the implementation of interventions to address increasing patient needs. Methods: This selected, brief review of the literature sought to describe published psychologically-based interventions delivered in inpatient medical settings. A search for studies catalogued on PubMed from 2007 to 2016 was examined and studies were included in the review if they were delivered within inpatient medical settings. Two reviewers independently assessed relevant studies for criteria. Results: A total of ten articles met the inclusion criteria with interventions targeting outcomes across four primary domains: 1) pain and fatigue; 2) cognition; 3) affective/emotional and; 4) self-harm. Several articles support interventions grounded in Cognitive-Behavioral Therapy and brief psychological interventions. Most studies reported favorable outcomes for the interventions relative to controls. Conclusions: Psychologically-based interventions, especially those that integrate components of cognitive-behavioral therapy and a multidisciplinary approach, can be implemented in inpatient medical settings and may promote improved patient outcomes. However, the quality of this evidence requires formal assessment, requiring more comprehensive reviews are needed to replicate findings and clarify effectiveness of interventions.
Original ArticleDesign and implementation of a randomized.docxgerardkortney
Original Article
Design and implementation of a randomized
trial evaluating systematic care for bipolar
disorder
Abundant evidence demonstrates that treatments
for bipolar disorder can reduce the severity of
mood symptoms and improve daily functioning.
Specific pharmacotherapies have been proven effi-
cacious in the acute management of mania and
depression (1, 2) as well as in the prevention of
recurrence (1). For lithium, more intensive treat-
ment has been shown to improve both long-term
clinical outcomes and psychosocial functioning.
Promising evidence also supports the efficacy of
several disease-specific psychosocial interventions
for bipolar disorder (3, 4).
Unfortunately, treatments provided in everyday
practice fall far short of those proven in clinical
Simon GE, Ludman E, Unützer J, Bauer MS. Design and implementation
of a randomized trial evaluating systematic care for bipolar disorder.
Bipolar Disord 2002: 4: 226–236. ª Blackwell Munksgaard, 2002
Objectives: Everyday care of bipolar disorder typically falls short of
evidence-based practice. This report describes the design and
implementation of a randomized trial evaluating a systematic program to
improve quality and continuity of care for bipolar disorder.
Methods: Computerized records of a large health plan were used to
identify all patients treated for bipolar disorder. Following a baseline
diagnostic assessment, eligible and consenting patients were randomly
assigned to either continued usual care or a multifaceted intervention
program including: development of a collaborative treatment plan,
monthly telephone monitoring by a dedicated nurse care manager,
feedback of monitoring results and algorithm-based medication
recommendations to treating mental health providers, as-needed outreach
and care coordination, and a structured psychoeducational group
program (the Life Goals Program by Bauer and McBride) delivered by the
nurse care manager. Blinded assessments of clinical outcomes, functional
outcomes, and treatment process were conducted every 3 months for
24 months.
Results: A total of 441 patients (64% of those eligible) consented to
participate and 43% of enrolled patients met criteria for current major
depressive episode, manic episode, or hypomanic episode. An additional
39% reported significant subthreshold symptoms, and 18% reported
minimal or no current mood symptoms. Of patients assigned to the
intervention program, 94% participated in telephone monitoring and 70%
attended at least one group session.
Conclusions: In a population-based sample of patients treated for bipolar
disorder, approximately two-thirds agreed to participate in a randomized
trial comparing alternative treatment strategies. Nearly all patients
accepted regular telephone monitoring and over two-thirds joined a
structured group program. Future reports will describe clinical
effectiveness and cost-effectiveness of the intervention program compared
with usual care.
Gregory E Simona, Evette
Lud.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
2. of chronic diseases, in particular study results for the treat-
ment of tinnitus [9], cardiac rehabilitation patients [10,11],
or oncological patients [12], reveal the effectiveness of
music therapy also in primary care settings.
Under these circumstances music therapy concepts are
of fundamental interest for the continuity of care between
in- and outpatient treatment. In particular, severely
impaired or geriatric patients discharged from hospital
risk losing therapeutic continuity because they are often
not able to attend day care centres where music therapy is
provided. Therefore, two major directions have been
established within the field of music therapy. On the one
hand, community music therapy programs focusing on the
social and cultural relations of the client and establishing
music therapy within his or her social context [13]; on the
other hand, music therapy initiatives providing home-
based music therapy (HBMT) in manifold projects are of
increasing importance [14]. Such HBMT-approaches
focus on the perspective of a patient’s condition after clinic
or rehabilitation and the continuity of the therapeutic pro-
cess. Specifically for patients after a traumatic brain injury,
chronic diseases as well as in palliative and dementia care,
a long term treatment concept should include not only
functional therapies but also mind-body interventions like
music therapy in order to meet the emotional, social, and
communicative needs of a patient and to accompany him
or her in their coping process [15].
For the first time, this systematic overview focuses on
settings and conditions of home-based music therapy
programs. The main questions were whether and if so
how HBMT can be part of an innovative and effective
service for people who have to be treated at home.
Methods
The following electronic databases were used to find arti-
cles on home-based music therapy: AMED, CAIRSS,
EMBASE, MEDLINE, PsychINFO, and PSYNDEX. Data-
bases were searched from their inception until 2010. The
search terms were “home-based music therapy” and
“mobile music therapy”. In addition, an internet search
was performed using Google Scholar. All articles found
this way were fully read and their reference lists were
checked for further relevant publications. To address a
wide range of HBMT, there were no limitations in the
initial search in terms of language, year, status, and form
of publication. One of the inclusion criteria for all publi-
cations was that the music therapy services had to take
place in the home of the clients. Therefore, all publica-
tions on other out-patient music therapy services were
excluded. The complete search strategy together with the
number of excluded studies is given in Figure 1.
If a study was found to be eligible, its methodological
quality was assessed by two independent reviewers and
recorded on a pre-determined checklist together with the
basic trial data regarding participants, interventions,
settings, outcomes, and study designs (PICOS) [16].
This specifically included quality and duration of MT
intervention and appraisal of MT-specific outcomes. Dis-
agreements in data extraction were resolved by consensus.
Although blinding of patients in music therapy is not
applicable and thus the use of the JADAD score [17] is
problematic, the reviewers tried to grade the methodologi-
cal quality of the studies by the following checklist (inter-
rater assessment): adequate description of the study design
(retrospective, prospective, multicentre study), subject
assembly process (randomization, matched pairs, etc.),
comparability of groups, description of drop outs, alloca-
tion concealment, description of the intervention, descrip-
tion of statistical analysis, external validity (representative
patients, relevant therapeutic concepts, generalization of
results).
As the anticipated outcome was assumed to be a mix-
ture of approaches, settings, legal aspects and outcomes
relating to the perspectives of the patients, caregivers,
and relatives and also due to the expectation of a quite
heterogeneous data with respect to study design and
used outcome measures, the authors decided against
carrying out a meta-analysis of the results and decided
to present the findings in a qualitative data synthesis.
Results
In total, the search identified 93 records after removing
duplications. Of those, 61 did not sufficiently cover the
field of home-based music therapy or were related to
other therapeutic interventions. Thirty-two publications
were found to be eligible for full text screening. How-
ever, another 15 articles had to be excluded due to rea-
sons of setting while three additional articles, which had
not been found by the database search, were retrieved
from contacted authors (See Figure 1).
Finally, 20 international publications from the United
States (n = 8), Germany (n = 4), Australia (n = 5), Austria
(n = 1), Japan (n = 1), and New Zealand (n = 1) were
included in the qualitative synthesis (see Tables 1 and 2
for details). From those 20 publications, 11 are clinical
studies and nine are reports from practice including field
or project reports with single case studies or special
music therapy programs for HBMT as well as legal and
administrative aspects of HBMT. The 11 studies investi-
gate the effectiveness of HBMT on certain symptoms,
mainly on depression, anxiety, distress, and pain [18-21],
but also on dyspnea [22], the length and quality of life
[23], or the promotion of social skills from autistic
children [24,25]. Four studies concentrate on the ques-
tion of how HBMT could meet not only the needs of the
patients, but also the needs of caregivers, spouses, and
families [26-29]. One study investigates new strategies to
improve therapy outcomes of depression treatment due
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Page 2 of 10
3. to the fact that only less than half of the diagnosed
patients with depression seem to respond to psychosocial
or antidepressant treatment [18].
Although cost effectiveness of HBMT is an intrinsic
motivation for most of the studies, it is mentioned
directly by only one author [19].
To establish a level of quality and understanding of
the search and the results of this review, the authors
decided to analyze only the 11 clinical studies. With
respect to music therapy as a young discipline in health
services research and the pioneering character of home-
based music therapy work in practice, the nine reports
and technical papers are listed in Table 2.
Study design
Of the 20 publications, 11 describe outcome studies.
Although all studies can be considered small with respect
to the number of patients involved, the methodological
quality of the studies can be regarded to be quite high. All
studies clearly name the outcome parameters, with the
majority having a reduction of symptoms like depression
or pain or an improvement of quality of life and the rela-
tionship between patients and caregivers as primary end-
points. Six studies have a randomized controlled design.
The randomized studies include a total of 507 patients,
varying form n = 14 to 203 with a mean of 85 participants.
A closer analysis of the studies with a modified JADAD
score [17] resulted in scores between 1 and 2 due to the
impossibility of blinding in music therapy.
Settings and Interventions
The studies on HBMT show a variety of music therapy
interventions and techniques, including active as well as
receptive music therapy approaches, and, in one study,
Individualized Music-focused Audio Therapies (I-
MATs) [18]. Although both active and receptive music
therapy can be found in home-based settings, music lis-
tening programs play an important role [21,22,27]. In
only a few studies, the therapist offered both active and
receptive music therapy [24,25].
The musical repertoire offered to the patients contains
classical music, new age music or easy listening music
Figure 1 Flowchart of the literature review process.
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Page 3 of 10
4. Table 1 Studies in HBMT
Authors Year Country Participants/
Conditions
Purpose of the study Intervention/HBMT Technique Comparison Outcomes Study design
Hanser, SB &
Thomson, LW
1994 USA 30 depressed home-
bound adults ranged
in age from 61 to 86
To examine a music-
facilitated
psychoeducational strategy
as a cost-effective and
accessible intervention
8 week program of receptive MT
including 8 MT-techniques
combined with mind/body
interventions
Three groups with 10
patients each: (1) HBMT,
(2) phone administered,
and (3) control
Both HBMT and self-
administered MT significantly
increased in tests of
depression, distress, self-
esteem, and mood and
remained stable after 9
month follow up
3-armed RCT
with 9-month
follow-up
Shiraishi, IM 1997 USA 14 multi-risk mothers
ranged in age from
21 to 41 years
To explore the prevalence
of anxiety and depression
and the effectiveness of MT
on these symptoms
8 week program of receptive MT Three groups: (1) control
(n = 4), (2) phone
administered (n = 5) and
(3) HBMT (n = 5)
Both HBMT and phone
administered MT decreased
depression and increased
self-esteem levels. HBMT had
subjective better gains than
phone administered mothers
3-armed RCT
McBride, S 1999 USA 24 patients with
chronic obstructive
pulmonary disease
(COPD) (mean age: 69
± 5,7 years)
To examine the feasibility
of using music as an
intervention for dyspnea
and anxiety
Receptive instrumental MT
(classical, new age, easy listening)
on an individual schedule
No comparison Using preferred music as an
intervention led to a decline
of dyspnea and anxiety
Single armed
observational
study with
repeated
measures
Hilliard,, RE 2003 USA 80 adults diagnosed
with terminal cancer
(mean age: 66 years
(MT group) and 65
(control group)
To evaluate the effects of
MT on quality of life and
length of life in care
Individualized music therapy with
a variety of interventions, e.g.
singing, listening or instrument
playing
Two groups: (1) Routine
hospice services and MT
versus (2) routine hospice
services only
Results clearly support music
therapy in hospice and
palliative care for improving
quality of life of people
diagnosed with terminal
cancer
Randomized
experimental
control-group
design
Pasiali, V 2004 USA 3 children (7,8 and 9
years old) with autism
(diagnosis ranging
from high functioning
to mildly impaired)
To investigate the effect of
presciptive songs on
promoting social skills
aquisition by autistic
children
Prescriptive therapeutic songs No comparison Results are not conclusive,
but there are some hints that
prescriptive songs are a
viable intervention for
children with autism
Three case
studies with
ABAB reversal
design
Siedlecki, SL 2005 USA 60 patients aged from
21 to 65 with chronic
non-malignant pain
(CNMP)
To examine the effect of
two music-listening
interventions on measures
of power, pain, depression,
and disability in individuals
with chronic non-malignant
pain
Two music-listening interventions:
a standard music (SM)
intervention and a patterned
music therapy (PM) intervention
with pleasant familiar
instrumental or vocal music or
the sounds of nature
Three groups: (1)
standard care without
MT, (2) standard music
interventions, (3) a
patterned music therapy
Both music-listening
interventions were equally
effective for increasing
power, and decreasing pain,
depressive symptoms, and
disability associated with
CNMP. Patients were taught
to use music at home to
moderate these symptoms
3 armed RCT
Muthesius, D 2005 Germany 40 patients with
dementia
To explore the effectiveness
of HBMT and the linked
support for the caring
situation
Singing songs and playing
familiar music
No comparison Similar effects to in-house
treatment like emotional
support or orientation. More
and detailed biographical
details from patients, their
musical resources support
carers and relatives to get
positive impressions of the
patients
Observational
study with
nested in
single case
vignettes
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5. Table 1 Studies in HBMT (Continued)
Chiang, JYK 2008 New
Zealand
4 carers (three
mothers and one
speech-langu age
therapist) of children
with special needs
To investigate how
carergivers and other
professionals perceive the
music therapy process over
time
Instrument playing, movement
and listening to music, and
singing of songs
No comparison From the perspective of
caregivers, music therapy
allows them to collaborate
with the music therapist. MT
contributes to the
development of reflective
skills for delivering effective
professional practice
Explorational
qualitative
study design
with semi-
structured
interviews
Baker, F et al. On-
going
Australia 120 couples where
one partner has a
probable diagnosis of
dementia
To advance the
understanding of MT-
techniques to enhance
spousal relationship and
reduce functional and
emotional strain on the
spousal caregiver
Singing familiar songs, movement
to music, listening to music
control: recreational reading
intervention
Two groups: (1) active
music intervention and
(2) control group with
recreational reading
Ongoing study 2 armed RCT
Thomas, A,
et al.
2009 Australia 191 clients of the
Eastern Palliative Care
(EPC) from 2007 to
2008
To evaluate the
effectiveness of single MT
in community based
palliative care. Perspectives
of clients, carers and
therapists are included
Live or recorded music provided
by Registered Music Therapists at
the EPC who are specifically
trained to support people in their
own home with music therapy
sessions
No comparison Music therapy supports
clients with a life-threatening
illness to maintain and/or
improve their quality of life
and also supports family
members in their role as
caregivers.
Observational
study with
nested in
qualitative
study
Brandes, V 2010 Austria 203 patients with
depression and/or
burnout and an
average age of 49,6
+13,1 years
To investigate new
strategies to improve
therapy outcomes in
psychosocial and
antidepressant treatment
Individualized short-term
receptive music therapy. MT was
administered as single therapy or
add-on therapy to
antidepressants and/or
psychotherapy
Four groups: (1) MT with
specific newly composed
music, (2) MT with
specially arranged
classical music, (3) a
placebo group receiving
nature sounds, and (4) a
waiting-list control group.
Individualized short-term
music therapy is beneficial as
alternative or complementary
depression treatment
4 armed RCT
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6. Table 2 Reports from HBMT-Practice
Author Year Country Type of
publication
Participants/Conditions Purpose of the publication Intervention/HBMT-
Technique
Outcomes
Oliver, S 1989 USA Journal
article
Developmentally disabled
adults and children, acute
and chronic psychiatric
adults
To report on music therapy services including
HBMT
Group and single
music therapy
Information related to conceptualizing,
initiating, and maintaining a private
practice in the music therapy field
Hanser, SB. 1990 USA Journal
article
4 depressed older adults in
age from 64 to 75 years
To document and evaluate the implementation of
a home based MT-technique
Eight music listening
programs in
conjunction with
known relaxation
methods
Four case studies describe successful
application of MT to older adults with
depression and/or anxiety
Horne-
Thompson,
A
2003 Australia Journal
article
Patients in palliative care To compare the role of music therapy within a
palliative care facility as opposed to a home
No detailled
information
The role of HBMT as opposed to the
hospital varies markedly. The necessity to
consider new ways to address the needs of
patients and their families is emphasized
Weber, S 2003 Germany Bachelor
thesis
Children from
underprivilegedfamilies
Review of legal and administrative aspects of HBMT
and a single case study
Half year family
intervention including
active single and
group music therapy
sessions
HBMT as a new form of socio-paedagogical
interventions is successful and cost
effective with respect to improvements in
family dynamics
Chapman,
A.
2004 Australia Conference
talk
Autistic children, a young
adult with a physical and
intellectual disability and an
older woman with dementia
To present practical experiences and considerations
on HBMT
Playing instruments,
singing songs,
vocalizing
Working in the home of a client and his/
her family allows current circumstances to
be incorporated and enhance this intimacy
Keller, B
et al.
2006 Germany Journal
article
Elderly people living at
home or in assisted living
settings
To report on music therapy services Multi-methods music
therapy
Hints and experiences for music therapists
applying HBMT are given
Mager, A 2006 Germany Journal
article
HBMT for elderly, disabled
and isolated patients
Position paper No detailed
information
Bringing music therapy to patients in
palliative care is considered to be a future
task
Roberts, M 2006 Australia Journal
article
Bereaved children and
adolescents
To document and compare three types of
songwriting in HMBT
Home-based
songwriting
Different styles (improvised, computer
based, original) of songwriting for HBMT
are described and explored
Mirenkov N
et al.
2009 Japan Journal
article
Elderly and disabled people
living at home
To present and evaluate a concept for applying
mobile MT to human-computer interfaces, based
on Quality of Life Supporters (QLS) of self-
explanatory type, and oriented to elderly and
disabled people
A selection of
precomposed classical
music with different
emotional characters
Presentation of a concept for applying
mobile music therapy with human-
computer interfaces
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7. like folk or pop songs. Brandes et al. [18] developed and
refined two specific listening programs, one with newly
composed polyphonic modern music and one with speci-
fically arranged classical music in their four-armed study.
Often the personal preferences of the individual cli-
ents are taken into account when choosing the music.
According to McBride [22], this is an important variable
in producing a relaxation effect. For the music listening
programs, the clients get basic technical equipment like
cassette players, headphones, as well as tapes with pre-
selected music.
Siedlecki [21] offered two music-listening programs in
her study: one group listened to a standard music program
(SM) and could choose from one of five relaxing instru-
mental music selections offered. For the second group,
patterned music therapy programs (PM) with pleasant
familiar instrumental or vocal music or the sounds of nat-
ure were offered to a) ease muscle tension or stiffness, b)
facilitate sleep or to decrease anxiety, c) improve mood
when someone feels sad, angry, or depressed, or d)
improve energy level when someone feels fatigued.
The combination of music listening programs with addi-
tional therapeutic techniques, like guided imagery, gentle
massages, or movement, was quite common [19,27].
Hanser & Thompson [19] presented an eight-step music
listening program on the basis of a cognitive-behavioural
technique. This program was facilitated especially for use
in the home environment and includes slow repetitive
music to enhance falling asleep, rhythmic music to
enhance energy, and also music listening in conjunction
with drawing or painting. McBride [22] relates to this
eight-step music listening protocol of Hanser & Thomp-
son in her work and gives her clients, who mainly suffer
from chronic obstructive pulmonary disease, precise
instructions on the use of music and how to use a music
diary to document how their dyspnea and anxiety may
have changed after listening to music.
In the field of active music therapy, singing and song
writing are very common [24-26]. Pasiali [25] describes
a three-step way from listening to singing for her work
with autistic children: first she sings the song for the cli-
ent accompanied by the guitar, then the client joins in
and plays rhythmical instruments, like maracas or sha-
ker eggs, to it and finally the client sings the song on
his or her own. Chiang [24] offers a ‘hello song’ at the
beginning and a ‘good-bye song’ at the end of a music
therapy session. Activities in her sessions may also
involve instrument playing, movement to music, listen-
ing, and singing.
In his study on music therapy with people with term-
inal cancer, Hilliard [23] describes that the techniques
of music therapists were singing, lyric analysis, and
music-prompted reminiscence as well as the planning of
funerals or memorial services.
The information on duration of sessions shows a wide
range: most authors reported that the average duration of
a session can be between 20 to 60 minutes [18,21,27,30].
The frequency differs from one hour each day for seven
days, to twice a day, and from a few times a week to as
often as the client wants or needs to have a treatment of
music therapy.
Date of publication
The dates of publication of the articles range from late
1980 to 2010. Four publications from the early years
mainly concentrate on conditions and the development
of special HBMT-programs, whereas from 2003 onward
there is an increasing interest in HBMT as a model of
ambulatory service and it is closely related to changes in
healthcare systems.
Fields of applications and patients
Fields of applications of HBMT are similar in all stu-
dies: the majority of clients are the elderly living at
home and people who need hospice and palliative care
[19,21,23,27-29]. For these groups, HBMT is an accessi-
ble intervention because often the patients are no
longer able to attend a hospital or a therapist’s office.
Another focus of HBMT is the work within the family-
system or with other caregivers or relatives [24-30].
This seems to be a specific and relevant aspect of
HBMT, which provides the opportunity for the interac-
tion and integration of family members and caregivers
in the music therapy process.
In their study on the treatment of depression, Brandes
et al. [18] argues that due to the fact that music therapy is
generally not associated with negative side effects, it can
be easily implemented with high treatment compliance.
Only the study from Pasiali [25] concentrates on
HBMT for children. She investigated how prescriptive
songs can promote the acquisition of social skills in
autistic children.
Legal aspects
Naturally, legal aspects of HBMT are very closely linked
to the peculiarities of the healthcare system of the speci-
fic country. For that reason the reports from out of
practice give relevant information on how a music
therapist can establish ambulatory work [31-33]. There
is an interesting tendency concerning the main focuses
of the publications; those from Germany mainly focus
on legal aspects and conditions of a HBMT-setting in a
changing healthcare system. Keller et al. [33] describe
their motivation of establishing HBMT directly linked
with the changes in healthcare politics and systems.
They developed several ambulatory services initially for
homes for the elderly and day care centres to address a
new spectrum of clients and paying authorities.
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8. Discussion
For the first time, this review presents an overview of
the field of home-based music therapy and describes
settings and conditions represented by an international
spectrum of articles.
According to our findings, publications on HBMT
cover two main aspects. The first is the search for new
fields and forms of work for music therapists alongside
with the changes in the health care systems. The second
aspect is to meet the challenges of a society with an
increasing number of chronically ill patients and people
of old age and low mobility and to adapt health care
services accordingly.
The publications on HBMT show that receptive music
therapy or singing songs with the clients play a predomi-
nant role in this working field. This might have organisa-
tional as well as economic reasons and takes into account
the conditions of the ambulatory setting where the music
therapist cannot carry too many instruments with him or
her. Also the client as well as his or her relatives can listen
to the music whenever it is wanted or needed. Accompa-
niment with a CD can be helpful when singing familiar or
preferred songs. Nevertheless, further development and
investigation of music therapy techniques and programs
for the specific use in a home-based setting are important
for the future of HBMT. Such can be found in publica-
tions from Austria, Australia, and the United States.
The article by Horne-Thompson [34] might be helpful
for finding out specific aspects of working in the home
of a patient. She compares the role of music therapy
within palliative care facility, as opposed to home, and
looks at the differences of music therapy at a hospital
and at a patient’s home. Horne-Thompson states that
although similar aims are addressed, the differences
between hospital and home-based music therapy are
striking. The author found that four factors influence
the quality of a music therapy service in the home as
opposed to the hospital: a) The way in which music
therapy is introduced can ultimately determine whether
or not a patient will participate, b) The role of the
music therapist also varies enormously between a home
and a hospital. Whereas in a hospital, music therapists
are often perceived by patients as one of the less threa-
tening health professionals, offering pleasant music and
instruments, a visit at a patient’s home may be experi-
enced as invasive and intrusive due to the large number
of health professionals involved in a patient’s ambulatory
care. c) The session length between home and hospital
varies significantly; the direct contact time with a patient
in his or her home is more than double the time spent
with patients in the hospital. One possible explanation
for this observation might be that patients and relatives
often plan the daily schedule around the sessions which
then results in fewer interruptions. d) One of the main
differences is the presence of a spouse or family member
while music therapy takes place. This means that they
can give important and precise information about the
patient’s condition and can be involved in the session to
address not only the needs of the patient, but also the
needs of the family. Horne-Thompson [34] concludes
that while family members are often present during ses-
sions, the music therapist treats the family members
alongside the patient.
This aspect of HBMT as a kind of “systemic music
therapy approach” is the subject of several studies. Tho-
mas et al. [28] found that music therapy in palliative care
can assist family members in their role as caregivers
while providing quality time with their loved ones.
While spousal caregivers of people with dementia
experience the care for their spouse over long periods of
time as a significant burden with ever increasing physi-
cal, emotional, and social strain, in their ongoing study
Baker et al. [27] concentrate on the relationship of per-
sons with dementia and their spousal caregivers. In this
study, several specific hypotheses focusing on the care-
giver’s perceived quality of the spousal relationship as
well as the caregiver’s satisfaction with the care follow-
ing the home-based music therapy intervention are
tested. The authors assume that the promotion of the
caregiver’s well-being can keep committed couples living
together in their own home and has, therefore, signifi-
cant economizations. As the study is in progress, there
are no results of this very interesting perspective of
HBMT at the moment.
In her pilot project, Muthesius [29] investigated how
music therapy can support caregivers and caring condi-
tions in the home-based care setting of gerontopsychia-
tric patients. Muthesius was able to show that for
people with dementia HBMT can not only relieve the
strain on the care-recipients but also on the caregivers.
Chiang [24] presumes that music therapy in a home
environment could help to enhance the child-parent
bond. It is also more convenient for the family as HBMT
is saving both caregiver and child from travelling to the
sessions and it gives opportunities to other family mem-
bers to be involved and get to know what music therapy
is all about. Parents view music therapy as beneficial and
enjoyable for their hospitalised child. Parents reported
that music therapy could support them in understanding
their child’s ability to learn through music and how they
could use music to interact with their child.
Limitations of this review
Although we are confident that our literature search
with an extensive internet search, hand-searching of
grey literature and relevant conference proceedings and
Schmid and Ostermann BMC Health Services Research 2010, 10:291
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Page 8 of 10
9. communication with experts in the field has identified
all relevant papers on HBMT, there might still be
unexploited sources of studies we might have missed.
However, according to Mc Auley [35], grey literature
tends to include small trials with inconclusive results
and thus this might not influence the conclusion of this
review on the level of outcome. Nevertheless, on the
level of implementation of services, valuable information
might still be overseen this way. This limitation also
holds for excluding publications from Asia. We are
aware that the healthcare systems in countries like Japan
or China are different than Western healthcare systems;
however, it might be interesting to explore how outpati-
ent services are realized under different conditions. In
our review, only the paper of Mirenkov et al. [36] gives
some insights into HBMT in Japan, mainly from the
technical site. However, according to the fact sheet of
music therapy in Japan from Ikuno [37], the typical
population and the places music therapists work seem
to be comparable. In particular, Ikuno points out that
music therapy for developmentally disabled children is
provided in the home of the client or therapist.
Finally, our internet search discovered a lot of HBMT
initiatives in different countries which seem to be imple-
mented in communal healthcare services. Unfortunately,
a closer investigation did not reveal any publications
about the outcomes of these services. As most of these
services are integrated into local healthcare services for
a longer time, successful outcomes can be assumed. In
total, despite efforts to find all relevant publications, we
can only give a fragmented view of the current state of
play of HBMT without drawing a representative picture.
Conclusion
The main questions for this systematic overview were
whether HBMT can be part of an innovative and effec-
tive service for people who have to be treated at home
and, if this is possible, how could it be implemented. It
was of particular interest to identify the types of clients
and conditions that can be addressed by HBMT and to
understand which specialized MT-approaches and set-
tings are needed for a home-based service.
As a result of this review, there are only a few music
therapy initiatives in the field of HBMT so far and
quite a small number of clinical research publications
in this area. Nevertheless, we were able to detect dis-
tinct fields of application for HBMT and special tech-
niques for home-based services. The growing interest
in HBMT in the last 10 years may indicate the poten-
tial of this service and refer to several advantages of
HBMT as a future service in healthcare systems.
HBMT is interesting for music therapists as well as for
special groups of patients and their families and care-
givers. This goes alongside the changing healthcare
systems and its changing conditions but also it meets
therapeutic challenges and needs of an ageing society
with an increasing number of elderly and severely
impaired people [38,39].
The possibility of integrating spouses, family members,
or caregivers in HBMT and instructing them in selected
music therapy techniques is an interesting aspect of
future HBMT-services in view of lasting and economical
aspects. It should be investigated in further studies. We
would like to encourage researchers and music thera-
pists to make distinct differentiations of approaches
with clear research-based concepts for special groups of
patients and to publish their results.
In a more global scope of public health, HBMT could
serve as a blueprint for other researchers in the expand-
ing field of home-based care services. Knowing more
about the problems and challenges before implementing
home-based care services may help to reduce the efforts
in structural planning and to improve the quality of psy-
chosocial support. This is not only limited to related
interventions like art therapy, but also may hold true for
other kinds of individualized mind-body therapies
applied to an ever-growing amount of patients who are
unable to leave their homes.
Acknowledgements
We would like to thank Katja Boehm and Katie Renaud for copyediting the
paper. We also would like to thank all the authors of the papers mentioned
in this review for their interest, cooperation, and support in screening the
field of HMBT.
Author details
1
The German Center for Neurodegenerative Diseases (DZNE), Witten,
Germany. 2
Center of Integrative Medicine & Chair of Medical Theory,
Integrative and Anthroposophical Medicine, Witten/Herdecke University,
Herdecke, Germany.
Authors’ contributions
WS and TO both developed the research design for the review. WS was
responsible for the literature research and TO screened the grey literature
and contacted the corresponding authors. WS was mainly responsible for
the data extraction, while TO cross-checked the results. Both WS and TO
carried out the qualitative analysis, discussed the results, and wrote the
paper.
Competing interests
The authors declare that they have no competing interests.
Received: 12 April 2010 Accepted: 14 October 2010
Published: 14 October 2010
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Cite this article as: Schmid and Ostermann: Home-based music therapy
- a systematic overview of settings and conditions for an innovative
service in healthcare. BMC Health Services Research 2010 10:291.
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