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”.
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.
Due to a diversified society, many of modern people are under stress and anxiety which cause
mental illnesses. Moreover, the social costs of psychotherapy and solution is so high that it cannot be limited to
a problem for individuals realistically. In this paper, we implement an m-Health application that can provide
preemptive art therapy services to reduce social costs and medical expenses. The implementation of the mHealth
application for art therapy has an advantage that social consideration class (the elderly, post-traumatic
stress disorder, etc.) can get treatment without leaving records by receiving medical welfare service of art
therapy in conjunction with professional therapist. Consultation clients are treated through the visit of a
professional therapist and the recorded videos are transmitted to a professional psychotherapy center server if
clients agree to shooting and recording of the processes. Based on the outcomes derived from the consultation
processes, we aim to build a database of the medical records and the new treatment program and apply it to mHealth.
Therefore, we expect to establish the criteria of objectivity, quantify, accuracy and the automaticity of
psychological treatment analysis.
The Impact of Patients’ Disease-Labels on Disease Experience Living Longer ...semualkaira
Advances in oncology have resulted in prolonged disease trajectories, also for patients with incurable cancer. This has induced discussions about the ‘right’ medical terminology. The impact of choosing a specific disease-label on well-being can be high.
The Impact of Patients’ Disease-Labels on Disease Experience Living Longer ...semualkaira
Advances in oncology have resulted in prolonged disease trajectories, also for patients with incurable cancer. This has induced discussions about the ‘right’ medical terminology. The impact of choosing a specific disease-label on well-being can be high.
Evaluating the Quality of Life and Social Support in Patients with Cervical C...CrimsonpublishersTTEH
Aims: Purposes of this descriptive correlational research were to 1) describe quality of life and social support and 2) look at the correlation of certain factors and quality of life in women with cervical cancer after treatment. Methods: Fifty-three women diagnosed with cervical cancer who were followed up after finished the treatments at the Gynecological outpatient department of a university hospital in 2016.They were asked to fill 3 questionnaires; 1) the general information; 2) Social support; and 3) Functional Assessment of Chronic Illness Therapy (FACT-Cervix). Alpha Cronbach’s coefficients for the social support was .73 and for the FACT-Cervix was .91. Data were analyzed by descriptive statistic and Spearman Rank Test.Result: Results showed that participants’ age was ranged from 30 to 86, mean=55.15 (SD=10.05). Social support was about 29 to 59, mean=48.23 (SD=6.76). Symptom distress was from 0 to 9, mean=3.36 (SD=2.83). For quality of life was diverted from 75 to159, mean=126.02 (SD=21.09). The results discovered that there was no correlation between age and social support with the quality of life, however, there was negative correlation between symptom distress and quality of life with r=-.40 at p=0.003.Conclusion: This study disclosed that social support for this women’s group could not help to improve their quality of life. Their symptom distress seems to have a direct effect on their QOL. Thus, the healthcare team needs to alleviate patients’ distress in order to improve the quality of life in cervical cancer survivors.
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.
Due to a diversified society, many of modern people are under stress and anxiety which cause
mental illnesses. Moreover, the social costs of psychotherapy and solution is so high that it cannot be limited to
a problem for individuals realistically. In this paper, we implement an m-Health application that can provide
preemptive art therapy services to reduce social costs and medical expenses. The implementation of the mHealth
application for art therapy has an advantage that social consideration class (the elderly, post-traumatic
stress disorder, etc.) can get treatment without leaving records by receiving medical welfare service of art
therapy in conjunction with professional therapist. Consultation clients are treated through the visit of a
professional therapist and the recorded videos are transmitted to a professional psychotherapy center server if
clients agree to shooting and recording of the processes. Based on the outcomes derived from the consultation
processes, we aim to build a database of the medical records and the new treatment program and apply it to mHealth.
Therefore, we expect to establish the criteria of objectivity, quantify, accuracy and the automaticity of
psychological treatment analysis.
The Impact of Patients’ Disease-Labels on Disease Experience Living Longer ...semualkaira
Advances in oncology have resulted in prolonged disease trajectories, also for patients with incurable cancer. This has induced discussions about the ‘right’ medical terminology. The impact of choosing a specific disease-label on well-being can be high.
The Impact of Patients’ Disease-Labels on Disease Experience Living Longer ...semualkaira
Advances in oncology have resulted in prolonged disease trajectories, also for patients with incurable cancer. This has induced discussions about the ‘right’ medical terminology. The impact of choosing a specific disease-label on well-being can be high.
Evaluating the Quality of Life and Social Support in Patients with Cervical C...CrimsonpublishersTTEH
Aims: Purposes of this descriptive correlational research were to 1) describe quality of life and social support and 2) look at the correlation of certain factors and quality of life in women with cervical cancer after treatment. Methods: Fifty-three women diagnosed with cervical cancer who were followed up after finished the treatments at the Gynecological outpatient department of a university hospital in 2016.They were asked to fill 3 questionnaires; 1) the general information; 2) Social support; and 3) Functional Assessment of Chronic Illness Therapy (FACT-Cervix). Alpha Cronbach’s coefficients for the social support was .73 and for the FACT-Cervix was .91. Data were analyzed by descriptive statistic and Spearman Rank Test.Result: Results showed that participants’ age was ranged from 30 to 86, mean=55.15 (SD=10.05). Social support was about 29 to 59, mean=48.23 (SD=6.76). Symptom distress was from 0 to 9, mean=3.36 (SD=2.83). For quality of life was diverted from 75 to159, mean=126.02 (SD=21.09). The results discovered that there was no correlation between age and social support with the quality of life, however, there was negative correlation between symptom distress and quality of life with r=-.40 at p=0.003.Conclusion: This study disclosed that social support for this women’s group could not help to improve their quality of life. Their symptom distress seems to have a direct effect on their QOL. Thus, the healthcare team needs to alleviate patients’ distress in order to improve the quality of life in cervical cancer survivors.
A diagnosis of cancer represents a significant crisis for the child and their family. As the treatment for childhood cancer has improved dramatically over the past three decades, most children diagnosed with cancer today survive this illness. However, it is still an illness which severely disrupts the lifestyle and typical functioning of the family unit. Most treatments for cancer involve lengthy hospital stays, the endurance of painful procedures and harsh side affects. Many cancer patients experience a similar perfect storm of physical and emotional stress during treatment. This anxiety and worry can cause cracks in patients’ psychological and emotional foundation, leaving them even more vulnerable. To reduce Stress among children with cancer researcher conducted Art therapy sessions.
Participation of the population in decisions about their health and in the pr...Pydesalud
Póster presentado por Lilisbeth Perestelo en el congreso Summer Institute for Informed Patient Choice (SIIPC14) celebrado del 25 al 27 de junio de 2014 en Dartmouth, Hanover (EEUU). Web: http://siipc.org
Contacto: lperperr@gobiernodecanarias.org
EMPIRICAL STUDYThe meaning of learning to live with medica.docxSALU18
EMPIRICAL STUDY
The meaning of learning to live with medically
unexplained symptoms as narrated by patients in primary
care: A phenomenological�hermeneutic study
EVA LIDÉN, PhD1, ELISABETH BJÖRK-BRÄMBERG, PhD2 &
STAFFAN SVENSSON, MD3
1Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, 2Institute
of Environmental Medicine, Karolinska Institutet, Solna, Sweden, and 3Angered Family Medicine Unit, Angered, Sweden
Abstract
Background: Although research about medically unexplained symptoms (MUS) is extensive, problems still affect a
large group of primary care patients. Most research seems to address the topic from a problem-oriented, medical
perspective, and there is a lack of research addressing the topic from a perspective viewing the patient as a capable person
with potential and resources to manage daily life. The aim of the present study is to describe and interpret the experiences of
learning to live with MUS as narrated by patients in primary health-care settings.
Methods: A phenomenological�hermeneutic method was used. Narrative interviews were performed with ten patients
suffering from MUS aged 24�61 years. Data were analysed in three steps: naive reading, structural analysis, and
comprehensive understanding.
Findings: The findings revealed a learning process that is presented in two themes. The first, feeling that the symptoms
overwhelm life, involved becoming restricted and dependent in daily life and losing the sense of self. The second, gaining
insights and moving on, was based on subthemes describing the patients’ search for explanations, learning to take care of
oneself, as well as learning to accept and becoming mindful. The findings were reflected against Antonovsky’s theory of sense
of coherence and Kelly’s personal construct theory. Possibilities and obstacles, on an individual as well as a structural level,
for promoting patients’ capacity and learning were illuminated.
Conclusions: Patients suffering from MUS constantly engage in a reflective process involving reasoning about and
interpretation of their symptoms. Their efforts to describe their symptoms to healthcare professionals are part of this
reflection and search for meaning. The role of healthcare professionals in the interpretative process should be acknowledged
as a conventional and necessary care activity.
Key words: MUS, primary care, person centred care, phenomenological-hermeneutics
(Accepted: 19 March 2015; Published: 16 April 2015)
Medically unexplained symptoms (MUS) is a condi-
tion that affects a large but heterogeneous group
of people. The health services have so far been
unsuccessful in addressing the healthcare needs of
these people, partly because of outdated theories and
diagnostic systems that fail to encompass the com-
plexity of the patients’ health problems (Fink &
Rosendal, 2008). The lack of a medical explanation
and cure leaves patients and healthcare professionals
in a ...
Objective: To evaluate the utility of a targeted lecture in improving FP awareness amongst clinicians.
Design: This is a dual institution, prospective survey-based study assessing if an educational lecture can increase the likelihood of FP consideration, discussion, and referral.
Stigma and Family reaction among Caregivers of Persons Living with Cancerinventionjournals
Cancer stigma refers to a negative or undesirable perception of a person affected by cancer. Stigma can be internal—it can affect self-perception of survivors, causing guilt, blame or shame. It can also be enacted, causing discrimination, loss of employment or income, or social isolation. It can come from misinformation, lack of awareness and deeply-engrained myth.The present study consisted of 300 caregivers of persons with cancer was selected based on simple random sampling, and with inclusion and exclusion criteria. Those patients satisfying the inclusion and exclusion criteria and attending both outpatient and inpatient services of cancer specialty hospital in KIDWAI Bangalore, Karnataka were selected randomly. The data was collected from the patients & caregivers of persons living with cancer who fulfill the inclusion/exclusion criteria were taken up for the study after their consent. Semi structured interview schedule were used to understand the stigma and family reaction. The interviews and the instruments were administered by research experts.
DQ 2-1 responses 55. The Change Theory was a three-stage model o.docxelinoraudley582231
DQ 2-1 responses 5
5. The Change Theory was a three-stage model of change developed by Kurt Lewin. This model was also known as the unfreezing-change-refreezing model that can be used by health care professionals when making discussing treatment for patients (Manchester, et al, 2014). The unfreezing process involves making it possible for people to change their mind. This can be done by helping them overcome a resistance or introducing new information. It is a way to increase the driving forces away from the current situation, such as encouraging a patient to have a diagnostic heart catheter after they have had several episodes of chest discomfort, but is afraid of going to the hospital for a procedure. Change is when there is a change of thought, behavior, or something that moves one from their current or frozen situation. This can be described as the patient agreeing to proceed with the heart catherization, getting on appropriate medication, and following a healthier lifestyle. The Refreezing is established after then change has happened and there is a new habit. For example, after the patient has the heart catheterization, he or she adopts a healthier lifestyle by being compliant with medication and the physician’s treatment recommendations, eating a heart-healthy diet, and exercising.
Communication is more than sending a message from one person to another. Communication involves nonverbal communication such as tone, body language, dialect, paralanguage, proximity, touch, eye contact, gestures, posture, and more. Nonverbal communication between a physician and patient influences patient perception, such as patient satisfaction (Montague, Chen, Xu, Chewning, & Barrett, 2013). Verbal and nonverbal communication barriers such as healthcare jargon, language barriers, emotional barriers, differences in perception and view point, and physical disabilities. Environmental barriers can also disrupt and distort messages. To minimize disruptions and distortions in communication, health care professionals should eliminate noise distractions by taking the patient to a quiet room or closing the door to the exam room or hospital room for privacy. One should speak clearly and slowly, checking for understanding before moving on to the next part of the message. Health care professionals should use a medical certified translator when there is a language barrier or hearing impairment. Reading the patient’s body language can also suggest if the patient is understanding and following along. Cell phones ringers should be turned off to not interrupt the communication. Eye contact demonstrates listening and understanding for both parties. Touch can be clinical and social (Montague, Chen, Xu, Chewning, & Barrett, 2013). A clinician must touch to the patient to assess, diagnose, and treat. However, touching through a handshake, hug, or pat on the back, can be social, therapeutic, and healing. The important part of communication is to make sure one’s message is recei.
Abstract:
It is difficult to find in Spanish a word that can translate the meaning of Counselling and encompassing all those elements and nuances that you are your own. The translations more frequently used are "assisted advice" and/or "aid relationship" and/or advice, it also includes all the skills that are necessary to establish that interpersonal relationship.
Although the communication skills, and in particular communication of bad news and the relationship with users are currently not part of the university education within the degree in Medicine, Nursing, Physiotherapy or Psychology if it has been of concern on the part of practitioners in these areas present sufficient levels of training in this core competency. In fact, we presented/displayed a communication where the little information received in the own hospital on the part of parents with children with Syndrome of Down is reflected in particular on this genetic alteration before making decisions referred to the birth from the boy. Thus, just as the curative art is learned can be learned the abilities of communication referred the unexpected news, which will help to diminish the psychological cost for the professional and the own patient.
Hace poco anunciamos el inicio de una sección en la revista Pediatría Integral, bajo el nombre de “Terapia cinematográfica en la infancia y adolescencia”, un guiño que quiere poner en relación la ciencia (pediátrica) con el arte (cinematográfico), y hacer del séptimo arte un instrumento más para cimentar la arteterapia en nuestro día a día.
Y bajo este concepto hoy damos comienzo a la primera “prescripción”, bajo el título de “Prescribir películas para adentrarnos en la infancia y adolescencia”. Porque nuestra especialidad se denomina como Pediatría y sus Áreas Específicas, lo que da a entender la amplitud, complejidad y complementariedad de nuestra profesión, que comprende todos los campos de la medicina y de la sanidad, y que abarca cronológicamente desde el nacimiento hasta que el niño llegue a la adolescencia, normalmente hasta los 18 años (aunque incluso hay organismos internacionales que extienden la edad hasta los 21 años) y donde se distinguen varios periodos: recién nacido (0-6 días), neonato (7-29 días), lactante (lactante menor; 1-12 meses de vida, lactante mayor; 1-2 años), preescolar (3-5 años), escolar (6-11 años), puberto (12-14 años) y adolescente (15-18 años).
Tras más de 720 películas comentadas hasta la fecha en el proyecto Cine y Pediatría, no resulta fácil seleccionar aquellas películas que destilen la esencia de esta etapa tan especial de la vida que es la infancia y adolescencia. Pero hoy hemos elegido siete películas que tienen dos características en común: son películas documentales (por lo que no son actores ni actrices sus protagonistas, sino niños y niñas reales) y son películas en francés (y queremos destacar el sentido y sensibilidad de la filmografía que llega desde Canadá, Bélgica y, principalmente, de Francia). Y todas ellas nos dan una visión poliédrica real de esta etapa compleja y maravillosa como es la infancia y la adolescencia (aunque a la adolescencia dedicaremos un capítulo monográfico, porque son tantas las películas enfocadas a esta etapa que llevamos tiempo reivindicándola como un género cinematográfico).
Estas películas son, por orden cronológico de estreno:
- Bebés (Bébé, Thomas Balme, 2010) 3, para entender la normalidad de un recién nacido y lactante.
- Solo es el principio (Ce n'est qu'un debut, Jean-Pierre Pozzi, Pierre Barougier, 2010) 4, para reconocer a los niños como nuestros pequeños filósofos.
- Camino a la escuela (Sur le chemin de l'école, Pascal Plisson, 2013) 5, para reflexionar sobre los distintos caminos que nos llevan a la escuela.
- A cielo abierto (À ciel ouvert, Mariana Otero, 2013) 6, para no olvidar que existen infancias con importantes problemas psiquiátricos.
- El gran día (Le grand jour, Pascal Plisson, 2015) 7, para homenajear el esfuerzo y la dedicación desde los primeros años para alcanzar un sueño, un himno a la esperanza y el coraje.
- Ganar al viento (Et les mistrals gagnants, Anne-Dauphine Julliand, 2016) 8, para demostrar que una hermosa vida con una enfermedad rara
Cada año nacen aproximadamente 15 millones de niños prematuros (< 37 semanas de gestación) en el mundo, de los cuales más de un millón muere antes de cumplir los 5 años. Es más, desde el año 2015 se ha establecido que los nacimientos prematuros son la principal causa de muerte infantil del mundo y, en muchos casos, aquellos bebés que logran sobrevivir pueden desarrollar patologías como retraso cognitivo, trastornos del neurodesarrollo, pérdida de visión o audición y hasta parálisis cerebral.
Unos pacientes donde es esencial que los cuidados sean de la mejor calidad científica y con el mayor nivel de humanización.
Foro de la Profesión Médica-La profesión médica defiende la equidad y cohesió...Javier González de Dios
En estos complicados momentos de la política española, con una sociedad dividida por las concesiones políticas, económicas y sociales que el PSOE ha prometido a determinadas Comunidades Autónomas que buscan la segregación de España, acaban de aparecer noticias preocupantes al respecto del sistema MIR que ha sido ya anunciado en prensa: “El PSOE abre la puerta a transferir el MIR a Cataluña, País Vasco y Galicia”. Una noticia frente a la que la comunidad médica muestra su más firme rechazo, por lo que supodría dinamitar un modelo de éxito.
Y en este sentido, el Foro de la Profesión Médica (conformado por el Consejo General de Colegios Oficiales de Médicos –CGCOM, la Federación de Asociaciones Científico Médicas de España – FACME, la Confederación Estatal de Sindicatos Médicos - CESM, la Conferencia Nacional de Decanos de Facultades de Medicina - CNDFM y el Consejo Estatal de Estudiantes de Medicina – CEEM) acaba de publicar este documento, consensuado este fin de semana, y en el que se defendiede la equidad y la cohesión nacional del sistema MIR actual y la necesidad de cumplir con las directivas europeas para homologación de títulos.
More Related Content
Similar to The value of music therapy in the expression of emotions in children with cancer
A diagnosis of cancer represents a significant crisis for the child and their family. As the treatment for childhood cancer has improved dramatically over the past three decades, most children diagnosed with cancer today survive this illness. However, it is still an illness which severely disrupts the lifestyle and typical functioning of the family unit. Most treatments for cancer involve lengthy hospital stays, the endurance of painful procedures and harsh side affects. Many cancer patients experience a similar perfect storm of physical and emotional stress during treatment. This anxiety and worry can cause cracks in patients’ psychological and emotional foundation, leaving them even more vulnerable. To reduce Stress among children with cancer researcher conducted Art therapy sessions.
Participation of the population in decisions about their health and in the pr...Pydesalud
Póster presentado por Lilisbeth Perestelo en el congreso Summer Institute for Informed Patient Choice (SIIPC14) celebrado del 25 al 27 de junio de 2014 en Dartmouth, Hanover (EEUU). Web: http://siipc.org
Contacto: lperperr@gobiernodecanarias.org
EMPIRICAL STUDYThe meaning of learning to live with medica.docxSALU18
EMPIRICAL STUDY
The meaning of learning to live with medically
unexplained symptoms as narrated by patients in primary
care: A phenomenological�hermeneutic study
EVA LIDÉN, PhD1, ELISABETH BJÖRK-BRÄMBERG, PhD2 &
STAFFAN SVENSSON, MD3
1Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, 2Institute
of Environmental Medicine, Karolinska Institutet, Solna, Sweden, and 3Angered Family Medicine Unit, Angered, Sweden
Abstract
Background: Although research about medically unexplained symptoms (MUS) is extensive, problems still affect a
large group of primary care patients. Most research seems to address the topic from a problem-oriented, medical
perspective, and there is a lack of research addressing the topic from a perspective viewing the patient as a capable person
with potential and resources to manage daily life. The aim of the present study is to describe and interpret the experiences of
learning to live with MUS as narrated by patients in primary health-care settings.
Methods: A phenomenological�hermeneutic method was used. Narrative interviews were performed with ten patients
suffering from MUS aged 24�61 years. Data were analysed in three steps: naive reading, structural analysis, and
comprehensive understanding.
Findings: The findings revealed a learning process that is presented in two themes. The first, feeling that the symptoms
overwhelm life, involved becoming restricted and dependent in daily life and losing the sense of self. The second, gaining
insights and moving on, was based on subthemes describing the patients’ search for explanations, learning to take care of
oneself, as well as learning to accept and becoming mindful. The findings were reflected against Antonovsky’s theory of sense
of coherence and Kelly’s personal construct theory. Possibilities and obstacles, on an individual as well as a structural level,
for promoting patients’ capacity and learning were illuminated.
Conclusions: Patients suffering from MUS constantly engage in a reflective process involving reasoning about and
interpretation of their symptoms. Their efforts to describe their symptoms to healthcare professionals are part of this
reflection and search for meaning. The role of healthcare professionals in the interpretative process should be acknowledged
as a conventional and necessary care activity.
Key words: MUS, primary care, person centred care, phenomenological-hermeneutics
(Accepted: 19 March 2015; Published: 16 April 2015)
Medically unexplained symptoms (MUS) is a condi-
tion that affects a large but heterogeneous group
of people. The health services have so far been
unsuccessful in addressing the healthcare needs of
these people, partly because of outdated theories and
diagnostic systems that fail to encompass the com-
plexity of the patients’ health problems (Fink &
Rosendal, 2008). The lack of a medical explanation
and cure leaves patients and healthcare professionals
in a ...
Objective: To evaluate the utility of a targeted lecture in improving FP awareness amongst clinicians.
Design: This is a dual institution, prospective survey-based study assessing if an educational lecture can increase the likelihood of FP consideration, discussion, and referral.
Stigma and Family reaction among Caregivers of Persons Living with Cancerinventionjournals
Cancer stigma refers to a negative or undesirable perception of a person affected by cancer. Stigma can be internal—it can affect self-perception of survivors, causing guilt, blame or shame. It can also be enacted, causing discrimination, loss of employment or income, or social isolation. It can come from misinformation, lack of awareness and deeply-engrained myth.The present study consisted of 300 caregivers of persons with cancer was selected based on simple random sampling, and with inclusion and exclusion criteria. Those patients satisfying the inclusion and exclusion criteria and attending both outpatient and inpatient services of cancer specialty hospital in KIDWAI Bangalore, Karnataka were selected randomly. The data was collected from the patients & caregivers of persons living with cancer who fulfill the inclusion/exclusion criteria were taken up for the study after their consent. Semi structured interview schedule were used to understand the stigma and family reaction. The interviews and the instruments were administered by research experts.
DQ 2-1 responses 55. The Change Theory was a three-stage model o.docxelinoraudley582231
DQ 2-1 responses 5
5. The Change Theory was a three-stage model of change developed by Kurt Lewin. This model was also known as the unfreezing-change-refreezing model that can be used by health care professionals when making discussing treatment for patients (Manchester, et al, 2014). The unfreezing process involves making it possible for people to change their mind. This can be done by helping them overcome a resistance or introducing new information. It is a way to increase the driving forces away from the current situation, such as encouraging a patient to have a diagnostic heart catheter after they have had several episodes of chest discomfort, but is afraid of going to the hospital for a procedure. Change is when there is a change of thought, behavior, or something that moves one from their current or frozen situation. This can be described as the patient agreeing to proceed with the heart catherization, getting on appropriate medication, and following a healthier lifestyle. The Refreezing is established after then change has happened and there is a new habit. For example, after the patient has the heart catheterization, he or she adopts a healthier lifestyle by being compliant with medication and the physician’s treatment recommendations, eating a heart-healthy diet, and exercising.
Communication is more than sending a message from one person to another. Communication involves nonverbal communication such as tone, body language, dialect, paralanguage, proximity, touch, eye contact, gestures, posture, and more. Nonverbal communication between a physician and patient influences patient perception, such as patient satisfaction (Montague, Chen, Xu, Chewning, & Barrett, 2013). Verbal and nonverbal communication barriers such as healthcare jargon, language barriers, emotional barriers, differences in perception and view point, and physical disabilities. Environmental barriers can also disrupt and distort messages. To minimize disruptions and distortions in communication, health care professionals should eliminate noise distractions by taking the patient to a quiet room or closing the door to the exam room or hospital room for privacy. One should speak clearly and slowly, checking for understanding before moving on to the next part of the message. Health care professionals should use a medical certified translator when there is a language barrier or hearing impairment. Reading the patient’s body language can also suggest if the patient is understanding and following along. Cell phones ringers should be turned off to not interrupt the communication. Eye contact demonstrates listening and understanding for both parties. Touch can be clinical and social (Montague, Chen, Xu, Chewning, & Barrett, 2013). A clinician must touch to the patient to assess, diagnose, and treat. However, touching through a handshake, hug, or pat on the back, can be social, therapeutic, and healing. The important part of communication is to make sure one’s message is recei.
Abstract:
It is difficult to find in Spanish a word that can translate the meaning of Counselling and encompassing all those elements and nuances that you are your own. The translations more frequently used are "assisted advice" and/or "aid relationship" and/or advice, it also includes all the skills that are necessary to establish that interpersonal relationship.
Although the communication skills, and in particular communication of bad news and the relationship with users are currently not part of the university education within the degree in Medicine, Nursing, Physiotherapy or Psychology if it has been of concern on the part of practitioners in these areas present sufficient levels of training in this core competency. In fact, we presented/displayed a communication where the little information received in the own hospital on the part of parents with children with Syndrome of Down is reflected in particular on this genetic alteration before making decisions referred to the birth from the boy. Thus, just as the curative art is learned can be learned the abilities of communication referred the unexpected news, which will help to diminish the psychological cost for the professional and the own patient.
Hace poco anunciamos el inicio de una sección en la revista Pediatría Integral, bajo el nombre de “Terapia cinematográfica en la infancia y adolescencia”, un guiño que quiere poner en relación la ciencia (pediátrica) con el arte (cinematográfico), y hacer del séptimo arte un instrumento más para cimentar la arteterapia en nuestro día a día.
Y bajo este concepto hoy damos comienzo a la primera “prescripción”, bajo el título de “Prescribir películas para adentrarnos en la infancia y adolescencia”. Porque nuestra especialidad se denomina como Pediatría y sus Áreas Específicas, lo que da a entender la amplitud, complejidad y complementariedad de nuestra profesión, que comprende todos los campos de la medicina y de la sanidad, y que abarca cronológicamente desde el nacimiento hasta que el niño llegue a la adolescencia, normalmente hasta los 18 años (aunque incluso hay organismos internacionales que extienden la edad hasta los 21 años) y donde se distinguen varios periodos: recién nacido (0-6 días), neonato (7-29 días), lactante (lactante menor; 1-12 meses de vida, lactante mayor; 1-2 años), preescolar (3-5 años), escolar (6-11 años), puberto (12-14 años) y adolescente (15-18 años).
Tras más de 720 películas comentadas hasta la fecha en el proyecto Cine y Pediatría, no resulta fácil seleccionar aquellas películas que destilen la esencia de esta etapa tan especial de la vida que es la infancia y adolescencia. Pero hoy hemos elegido siete películas que tienen dos características en común: son películas documentales (por lo que no son actores ni actrices sus protagonistas, sino niños y niñas reales) y son películas en francés (y queremos destacar el sentido y sensibilidad de la filmografía que llega desde Canadá, Bélgica y, principalmente, de Francia). Y todas ellas nos dan una visión poliédrica real de esta etapa compleja y maravillosa como es la infancia y la adolescencia (aunque a la adolescencia dedicaremos un capítulo monográfico, porque son tantas las películas enfocadas a esta etapa que llevamos tiempo reivindicándola como un género cinematográfico).
Estas películas son, por orden cronológico de estreno:
- Bebés (Bébé, Thomas Balme, 2010) 3, para entender la normalidad de un recién nacido y lactante.
- Solo es el principio (Ce n'est qu'un debut, Jean-Pierre Pozzi, Pierre Barougier, 2010) 4, para reconocer a los niños como nuestros pequeños filósofos.
- Camino a la escuela (Sur le chemin de l'école, Pascal Plisson, 2013) 5, para reflexionar sobre los distintos caminos que nos llevan a la escuela.
- A cielo abierto (À ciel ouvert, Mariana Otero, 2013) 6, para no olvidar que existen infancias con importantes problemas psiquiátricos.
- El gran día (Le grand jour, Pascal Plisson, 2015) 7, para homenajear el esfuerzo y la dedicación desde los primeros años para alcanzar un sueño, un himno a la esperanza y el coraje.
- Ganar al viento (Et les mistrals gagnants, Anne-Dauphine Julliand, 2016) 8, para demostrar que una hermosa vida con una enfermedad rara
Cada año nacen aproximadamente 15 millones de niños prematuros (< 37 semanas de gestación) en el mundo, de los cuales más de un millón muere antes de cumplir los 5 años. Es más, desde el año 2015 se ha establecido que los nacimientos prematuros son la principal causa de muerte infantil del mundo y, en muchos casos, aquellos bebés que logran sobrevivir pueden desarrollar patologías como retraso cognitivo, trastornos del neurodesarrollo, pérdida de visión o audición y hasta parálisis cerebral.
Unos pacientes donde es esencial que los cuidados sean de la mejor calidad científica y con el mayor nivel de humanización.
Foro de la Profesión Médica-La profesión médica defiende la equidad y cohesió...Javier González de Dios
En estos complicados momentos de la política española, con una sociedad dividida por las concesiones políticas, económicas y sociales que el PSOE ha prometido a determinadas Comunidades Autónomas que buscan la segregación de España, acaban de aparecer noticias preocupantes al respecto del sistema MIR que ha sido ya anunciado en prensa: “El PSOE abre la puerta a transferir el MIR a Cataluña, País Vasco y Galicia”. Una noticia frente a la que la comunidad médica muestra su más firme rechazo, por lo que supodría dinamitar un modelo de éxito.
Y en este sentido, el Foro de la Profesión Médica (conformado por el Consejo General de Colegios Oficiales de Médicos –CGCOM, la Federación de Asociaciones Científico Médicas de España – FACME, la Confederación Estatal de Sindicatos Médicos - CESM, la Conferencia Nacional de Decanos de Facultades de Medicina - CNDFM y el Consejo Estatal de Estudiantes de Medicina – CEEM) acaba de publicar este documento, consensuado este fin de semana, y en el que se defendiede la equidad y la cohesión nacional del sistema MIR actual y la necesidad de cumplir con las directivas europeas para homologación de títulos.
Una reflexión sobre la prevenciíon cuaternaria, con varias preguntas a responder y sobre las que reflexionar:
¿Dónde situamos los distintos tipos de actividades preventivas en la historia natural de la enfermedad?
¿Qué valor tiene el “punto crítico de irreversibilidad” de una enfermedad, así como el “tiempo de adelanto diagnóstico”?
¿Cuáles son los sesgos de las pruebas diagnósticas y de las pruebas de cribado?
¿Qué peso damos a los falsos positivos y al fenómeno de etiquetado en la evaluación de un programa de cribado?
¿Qué papel juega el efecto cascada en el entorno de la detección precoz de enfermedades?
La revista Pediatría Integral es el órgano de expresión de la Sociedad Española de Pediatría Extrahospitalaria y de Atención Primaria (SEPEAP), revista que ha superado ya sus bodas de plata desde que se inició su camino, una revista que ha mantenido su revisión y renovación a lo largo de los años. Es Pediatría Integral una revista con vocación en la formación pediátrica continuada, una puesta al día para mejorar nuestras competencias en las tres grandes dimensiones: saber (conocimientos), saber hacer (habilidades) y saber ser (actitudes). Y Pediatría Integral es un buen foro común que hoy renueva su camino con el inicio de una nueva sección que hemos titulado como “Terapia cinematográfica en la infancia y adolescencia”, un guiño que quiere poner en relación la ciencia (pediátrica) con el arte (cinematográfico), y hacer del séptimo arte un instrumento más para cimentar la arteterapia en nuestro día a día.
Una sección que se nutre del proyecto “Cine y Pediatría”, el cual nació casi sin querer en enero del año 2010 en el blog Pediatría basada en pruebas. Y como que no quiere la cosa, y gracias a la publicación semanal (todos los sábados, sin fallar uno) de un post dedicada a películas que tengan a la infancia y adolescencia como protagonistas (en sus aspectos de la pediatría clínica, social o preventiva), ya hemos publicado más de 720 post. Y desde el blog, “Cine y Pediatría” se ha convertido en realidad en la publicación de 12 libros (con el 13 en edición), uno por año, y con el título de “Cine y Pediatría. Una oportunidad para la docencia y la humanización en nuestra práctica clínica”. Y el proyecto continúa vivo, más vivo si cabe. Y con un objetivo: que los pediatras nos atrevamos a “prescribir” películas, al igual que prescribimos medicamentos, pruebas complementarias o, incluso, direcciones electrónicas de páginas de interés para nuestros pacientes y sus familias. Y para ello nos fundamentamos en estos cinco fundamentos: 1) que la Pediatría es una especialidad “de cine”; 2) que la infancia y adolescencia son los actores de nuestra vida y profesión; 3) que el arte de “prescribir” películas implica arte, ciencia y conciencia; 4) que es preciso aprender a mirar las películas bajo la observación narrativa (prefiguración, configuración y refiguración); y 5) que abogamos por prescribir películas relevantes en su relación con la Pediatría, tanto en su ámbito médico como social.
Y con la experiencia adquirida en el libro electrónico Trilogías del séptimo arte para pediatras “de cine”, estos son algunos de los temas que vamos a ir tratando en sucesivas entregas en Pediatría Integral:
- Películas para entender la infancia
- Películas para entender la importancia de ser pediatra
- Películas para entender las enfermedades raras
- Películas para entender las enfermedades oncológicas
- Películas para entender el trastorno del espectro autista
- Películas para entender otros trastornos del neurodesarrollo
- Películas para entender el síndrome de Down
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El Día Nacional de la Pediatría en España se celebra el 8 de octubre (o en sus fechas próximas si cayera en fin de semana). Y ello porque la Asociación Española de Pediatría consideró oportuno que esta primera jornada fuera el inicio de un evento que se celebrará anualmente con el objetivo de hacer presente la importante figura de la Pediatría y de los pediatras en nuestra sociedad, como valedores de la salud infanto-juvenil de nuestra población, reivindicando un modelo de asistencia pediátrica modélico y que no pocas veces se cuestiona.
a prevención cuaternaria: herramienta clave para el pediatra del siglo XXIJavier González de Dios
Compartimos la conferencia extraordinaria en el XX Congreso Internacional de Pediatría que se ha celebrado hace dos semanas en Mérida (Yucatán, México) y con el título de “La prevención cuaternaria: herramienta clave para el pediatra del siglo XXI”. Y que se ha desarrollado en estos apartados:
I. Aproximación a la CALIDAD EN SALUD II.
II. GESTIONAR en busca de la (H)EXCELENCIA
III. De la MEDICINA BASADA EN LA EVIDENCIA a la MEDICINA APROPIADA
IV. Profundizando en la PREVENCIÓN CUATERNARIA:
• Prevención cuaternaria y factores de riesgo
• Prevención cuaternaria y pruebas de diagnóstico/cribado
• Prevención cuaternaria y tratamiento
V. REFLEXIONES FINALES, que se pueden resumir así:
- Respecto a los factores de riesgo.
Evitar el EFECTO CASCADA de intervenciones médicas excesivas e innecesarias ante la actual “cultura del riesgo”: la simple asociación estadística entre un factor y una enfermedad (ej. dilatación piélica y anomalías nefrourológicas) se convierte en casi una enfermedad, o en causa necesaria y suficiente de la misma.
- Respecto a las pruebas diagnósticas/cribado.
Considerar en los cribados universales el PUNTO CRÍTICO DE IRREVERSIBILIDAD, el TIEMPO DE ADELANTO DIAGNÓSTICO y el valor de los FALSOS POSITIVOS y el FENÓMENO DE ETIQUETADO Porque no siempre más es mejor. Y hay que evitar la “arrogancia” de la medicina preventiva.
-Respecto al tratamiento.
La EVIDENCE-BIASED MEDICINE limita los resultados de la Evidence-Based Medicine. La “evidencia” es mucho más evidente cuando favorece a los intereses comerciales que a los intereses de los pacientes (ej. anticuerpos monoclonales frente al virus respiratorio sincitial).
Perceptions and attitudes of pediatricians and families with regard to pediat...Javier González de Dios
“Purpose This study aimed to identify the perceptions and attitudes of pediatricians and parents/caregivers regarding medication errors at home, and to compare the fndings from the two populations.
Methods This was a cross-sectional survey study. We designed a survey for working pediatricians and another one for parents or caregivers of children aged 14 years and younger. The survey’s questions were designed to assess provider and parental opinions about the difculty faced by parents providing medical treatment, specifc questions on medication errors, and on a possible intervention program aimed at preventing pediatric medication errors. Pediatrician and parent responses to matching questions in both surveys were compared.
Results The surveys were administered in Spain from 2019 to 2021. In total, 182 pediatricians and 194 families took part. Most pediatricians (62.6%) and families (79.3%) considered that managing medical treatment was not among the main difculties faced by parents in caring for their children. While 79.1% of pediatricians thought that parents consulted the internet to resolve doubts regarding the health of their children, most families (81.1%) said they con sulted healthcare professionals. Lack of knowledge among parents and caregivers was one of the causes of medication errors most frequently mentioned by both pediatricians and parents. Most pediatricians (95.1%) said they would recommend a program designed to prevent errors at home.
Conclusions Pediatricians and families think that medical treatment is not among the main difculties faced by parents in caring for their children. Most pediatricians said they would recommend a medication error reporting and learning system designed for families of their patients to prevent medication errors that might occur in the home environment.”
La ciencia abierta contribuye a aumentar la transparencia y fomentan la participación, la cooperación, la rendición de cuentas, la capacidad de reutilización del trabajo investigador, el impacto y la reproducibilidad de resultados. Así mismo, favorece la democratización y sostenibilidad de los sistemas de I+D+i y promueve la diversificación de perfiles en los grupos de investigación y la incorporación de actores no académicos en todo el ciclo del proceso investigador, desde el diseño del proyecto hasta su evaluación.
Por ello es importante poder conocer este documento del Ministerio de Ciencia y Educación, por título "Estrategia Nacional de Ciencia Abierta (ENCA) 2023 – 2027", y en el que se hace un buen análisis, a través de estos apartados:
- Contexto
- Misión y valor
- Análisis DAFO
- Objetivos estratégicos
- Ejes estratégicos y medidas de actuación por eje:
a) Infraestructuras digitales para la ciencia abierta.
b) Gestión de datos de investigación siguiendo los principios FAIR (Findable, Accesible, Interoperable, Reusable).
c) Acceso abierto a publicaciones científicas.
d) Incentivos, reconocimientos y formación.
- Gobernanza, plan de seguimiento y evaluación.
Nirsevimab y prevención de bronquiolitis en lacatantes nacidos a términoJavier González de Dios
Con motivo del último calendario de vacunaciones (ahora denominado de inmunizaciones) publicado por el Comité Asesor de Vacunas (CAV-AEP), en el que se expresa que “el CAV-AEP recomienda nirsevimab en todos los recién nacidos y lactantes menores de seis meses y su administración anual a niños menores de dos años con enfermedades subyacentes que aumenten el riesgo de infección grave por VRS”, el Comité de Pediatría Basada en la Evidencia acaba de publicar una Evidentia Praxis (que viene a ser una revisión sistemática y valoración crítica de todas las pruebas científicas alrededor de una pregunta clínica estructurada, que aquí corresponde a “En lactantes nacidos a término sanos, ¿es nirsevimab eficaz y seguro para prevenir bronquiolitis por virus respiratorio sincitial?”.
La reflexión final desde el Comité de Pediatría Basada en la Evidencia es: “Pero, ¿tenemos ya suficiente información para hacer una recomendación? ¿es ya el momento para extender su uso universal? Si tenemos en cuenta la carga de enfermedad y la potencial gravedad de las bronquiolitis encontramos argumentos a favor. Pero si consideramos las limitaciones de la evidencia disponible y la conveniencia de conocer los resultados de otros estudios en marcha, la urgencia de la decisión queda cuestionada, por lo que parece prudente esperar para hacer recomendaciones”
El CT-PBE es un comité compartido entre dos sociedades científicas (AEPap y AEP), constituido por pediatras de Atención Primaria y Hospitalaria de España y Latinoamérica, cuyos objetivos han sido y son: 1) asesorar metodológicamente en los protocolos y documentos de la AEP y AEPap; 2) fomentar la implicación de a AEP y AEPap en el desarrollo de GPC; 3( difundir la metodología de la MBE (talleres de búsqueda bibliográfica, lectura crítica, etc.); 4) publicar trimestralmente la revista Evidencias en Pediatría (EVP); 5) impulsar la formación continuada; 6) colaborar de forma habitual con otras revistas científicas (como Revista de Pediatría de Atención Primaria, RPAP, y Formación activa en pediatría de atención primaria, FAPap).
En la presentación se hablan de los cuatro proyectos desarrollados en el último año, alguno de los cuales ya han sido comentados en este blog:
- Guía de práctica clínica COVID 19 en Pediatría (con su versión del año 2021 y actualización del año 2022)
- Revista Evidencias en Pediatría, una revista viva y en continua evolución desde su fundación en el año 2005.
- Calcupedev, la herramienta de cálculo epidemiológico en Pediatría creada desde el propio CT-PBE
- Libro Medicina Basada en la Evidencia, en fase de elaboración y que recogerá el material creado por el CT-PBE durante estas casi dos décadas de existencia. Es el gran reto de este año 2023 y contará con 7 apartados: I. Introducción a la Medicina basada en la evidencia (8 capítulos); II. Diseños metodológicos (15 capítulos); III. Medidas epidemiológicas (7 capítulos); IV. Herramientas para la elaboración de documentos científicos (11 capítulos); V. Lectura crítica de documentos científicos (10 capítulos); VI. Estadística básica (18 capítulos); y VII. Herramientas y calculadoras epidemiológicas (4 capítulos).
En esta presentación, hemos querido responder a tres preguntas:
1. ¿Por qué nace PMRP?
Esta nueva sección de la plataforma Continuum, desarrollada por las diferentes sociedades de especialidad pediátricas de la AEP, se presenta como un complemento virtual de la formación MIR y tiene como propósitos
2. ¿Qué objetivos persigue PMRP?
Se podrían sintetizar en estos tres objetivos: disminuir la variabilidad en la formación de los especialistas en formación, asistir a los tutores en su función docente y facilitar el aprendizaje colaborativo y basado en competencias, el entrenamiento reflexivo y la resolución de problemas propios del perfil profesional de cada especialidad pediátrica por la que roten.
3. ¿Qué ventajas ofrece PMRP para residentes y tutores?
a) Ventaja para los residentes de Pediatría:
- Aprendizaje basado en escenarios clínicos
- Aprendizaje reflexivo
- Aprendizaje colaborativo y comunicación asíncrona
b) Ventajas para los tutores:
- Ayudar en su función docente
- Proporcionar herramientas para lograr evaluar los logros alcanzados
La conferencia se desarrolló en seis apartados:
I. El DÍA DEL LIBRO y los días de la Literatura
Donde se recuerda el 23 de abril como el Día Internacional del Libro y algunos pensamientos de literatos de habla española en relación con la importancia de los libros y la lectura.
II. Los 23 LIBROS MÁS VENDIDOS de la Historia
La literatura es indispensable en la Historia, que sin duda sería muy diferente si no tuviéramos libros para conocerla. El tiempo ha conservado aquellos libros que han pasado de generación en generación, siempre con éxito por uno u otro motivo. Y el éxito de ventas ser un buen marcador. Y un reciente estudio realizado sobre los libros impresos que más se vendieron en los últimos 50 años – sin tener en cuenta las ventas digitales - , nos da esta cifra de los 23 libros más vendidos de la historia. Elegimos el 23 en honor a ese 23 de abril, Día del Libro en nuestro país. Y en el top tres se encuentran “Don Quijote de la Mancha”, “Citas del presidentes Mao Tse-Tung” y “La Biblia”, esta última en un destacado e inalcanzable primer lugar.
III. Los 23 ESCRITORES más adaptados al Cine
La fusión entre cine y literatura comienza en los guiones adaptados a partir de obras literarias. Guión adaptado que se fundamenta en tres claves a aplicar a su novela de origen: adecuación lingüística, adecuación de personajes y adecuación al formato de cine. De nuevo elegimos la cifra de los 23 escritores más adaptados al cine y la televisión, listado que está encabezado por un podio (Dickens, Chéjov y Shakespeare, éste muy destacado), pero bien acompañado por otros autores (donde la única mujer es Agatha Christie y el único autor vivo es Stephen King).
IV. Novelas adaptadas en CINE Y PEDIATRÍA
En la parte nuclear de la exposición elegimos 40 películas ya publicadas en Cine y Pediatría y donde la relación con su libro de origen de la historia guarda una especial relación. Una relación cronológica que comienza con “El mago de Oz” (Victor Fleming, 1939) y el libro de cabecera de Lyman Frank Baum publicado en 1900, “The Wonderful Wizard of Oz”, hasta la última versión de “Mujercitas” (Greta Gerwing, 2019) en base a la legendaria obra de Louisa May Alcott publicada en 1868, “Little Women”. Un listado que incluye obras paradigmáticas versionadas a la gran pantalla como “Le avventure de Pinocchio” de Carlo Collodi, “Alicia en el País de las Maravillas” de Lewis Carroll, “The Lord of the Flies” de William Golding o “Le Petit Prince” de Antoine de Saint-Exupèry; pero también novelas menos conocidas como “El juego de los niños” de Juan José Plans, “¿Qué me quieres, amor?” de Manuel Rivas o “Los Pelones” de Albert Espinosa.
V. Un THE END con final feliz
Y cómo toda historia, esta exposición mejor que tenga un final feliz. Y es así que se presentó en primicia el libro Cine y Pediatría 12, adelantándose en tres semanas al acto que tendrá lugar en el XX Festival Internacional de Cine de Alicante. Y también dejamos la lectura de tres ideas finales:
En esta docente presentación en nuestro Servicio de Pediatría se destacan los cuatro momentos clave en la prescripción de antimicrobianos y que sirven para desarrollar las preguntas esenciales que aplican los principios de PROA:
1. ¿Está indicado el tratamiento antibiótico en este paciente?
2. ¿Cuál es el síndrome sospechado?
3. ¿Qué muestras microbiológicas debo extraer para el diagnóstico?
4. ¿Cuál es el antibiótico más apropiado?
5. ¿He aplicado las medidas para el control del foco de la infección?
Era el año 1987 cuando comencé mi Residencia de Pediatría en el Hospital Universitario La Paz (Madrid). Y mi primera rotación fue en Neonatología, en la conocida como Unidad de Transición Neonatal. Y ese fue mi primer contacto con “la 5ª” (como se le conocía entonces) durante seis meses, un servicio liderado en su jefatura por el Prof. José Quero, y con dos jefes de sección de la altura de los Dres. Félix Omeñaca y Jesús Pérez. Y fue allí mi primer contacto con el Dr. Quero, Pepe, como todos le conocíamos.
Y ese contactó se prolongó durante 15 meses al final de mi formación, cuando elegí formarme específicamente como neonatólogo con este equipo. Y allí se fraguó una relación profesional con Pepe, un doctor amante del estudio, afectuoso en la relación, ponderado en las decisiones y amable en las palabras. Cualidades tan apreciables (y poco comunes) para un jefe de servicio y catedrático de Pediatría de aquellos tiempos, lo que convirtió nuestra relación en afecto y amistad. De hecho, mi traslado a la provincia de Alicante hace más de tres décadas se lo debo a él, cuando él me informó y recomendó sobre aquella nueva Unidad Neonatal que se abría en el recién estrenado Hospital Universitario de San Juan.
Continuaron nuestros esporádicos contactos en los congresos científicos y siempre intentábamos vernos, comer juntos, preguntarnos por nuestra vida y nuestra familia. Y siempre iba aderezado por su permanente sonrisa. Lo que se dice, cultivar las relaciones personales que nos regala la vida.
Se jubiló Pepe en el año 2013, tras tres décadas al frente de la Jefatura de Servicio de Neonatología en el Hospital Infantil La Paz (la primera UCIN de España por aquellos inicios), con un amplio bagaje clínico, docente (como Catedrático de Pediatría de la UAM) e investigador, un maestro de muchos de los neonatólogos que hoy lideran esta especialidad en nuestro país. En el mes de enero de este año recibimos la triste noticia de su fallecimiento, y con su partida recuerdo como válido ese pensamiento de que “no es más grande quien más ocupa, sino quien más vacío deja cuando se va”. Y durante este tiempo se han compartido distintos homenajes (In Memoriam) en diferentes revistas y por diferentes amigos que dejó, que fueron muchos, homenaje que merecen las personas que son importantes en nuestra vida.
Quiero destacar el emotivo obituario de un amigo común, el Dr. Félix Omeñaca en Anales de Pediatría, el In Memoriam en la web de Fundación NeNe y en la revista Pediatric Research que os adjunto debajo, estas dos últimas lideradas por el Dr. Alfredo García-Alix.
Un texto de 67 páginas que, en palabras de su autor, el Prof. Manuel Cruz Hernández, "es un resumen de los 30 años de sobreviviente, más de un cuarto de siglo vivido, totalmente inesperado, cuando me llegó la impuesta y no deseada jubilación el 30 de septiembre de 1992, cubriendo la pesadumbre propia con el manto alegre de los Juegos olímpicos de Barcelona". Y es así, como si una bitácora personal y profesional fuera, describe tres décadas fructíferas (desde 1992 a 2022) en esa etapa de "júbilo" que le hace un ejemplo de aprovechar la vida y dar frutos (el texto se ha publicado a sus 97 años de edad).
Creo que una obra así no puede por menos que ser compartida, como ejemplo. Y con su permiso, así lo hago. Gracias, estimado maestro y amigo, Prof. Cruz Hernández. Su magisterio y ejemplo nos hace mejor a todos y usted es un paradigma de que las personas no son grandes por lo que tienen, sino por lo que son.
Una sesión que os invito a revisar, pues abordar aspectos muy prácticos como la habitación de despedida, cómo manejar la comunicación verbal y no verbal en estas situaciones, las frases a usar y las frases que evitar, qué hacer y qué no hacer, los cuidados del bebé y la caja de recuerdos, la posibilidad de donación de leche materna, los grupos de apoyo a los padres y también el cuidado emocional del profesional.
Enumeramos las conclusiones de esta interesante sesión clínica:
- En los últimos años se está adquiriendo una mayor sensibilización, han aumentado los estudios y las medidas y planes con el objetivo de mejorar la humanización en la atención del duelo perinatal y neonatal.
- Los profesionales sanitarios jugamos un papel fundamental durante este proceso proporcionando disponibilidad, apoyo emocional y respondiendo a las necesidades físicas, emocionales, psicosociales y espirituales del recién nacido y su familia mediante la creación de un entorno confortable y la humanización de los cuidados.
- Es necesario la formación de los profesionales sanitarios en el acompañamiento a familiares durante la muerte perinatal o neonatal y apoyo al personal sanitario tras este tipo de situaciones.
La adolescencia en el cine, un viaje a los coming of age. Congreso Virtual CO...Javier González de Dios
En el IV Congreso Virtual CONAPEME (Confederación Nacional de Pediatría de México) tuve la oportunidad de realizar la conferencia de clausura con el tema solicitado por la organización titulado "La adolescencia en el cine, un viaje a los coming of age".
Se conoce con el anglicismo coming of age a un género literario y cinematográfico que se centra en el crecimiento psicológico y moral del protagonista, a menudo desde la juventud hasta la vida adulta, y con epicentro en la adolescencia. Y con dos recursos habituales: la voz en off y el flashbacks (dos anglicismos más). Y se conoce con el germanismo bildungsroman (o novela de aprendizaje) a un subgénero específico del coming-of-age, presente en la literatura y centrado en el desarrollo psicológico y moral del protagonista. En ocasiones van de la mano.
Porque la adolescencia es una maravillosa etapa de transición y viaje desde la infancia previa al horizonte de una joven vida adulta (de ahí el anglicismo coming of age), con algunas señas de identidad: 1) búsqueda de la propia identidad, 2) rebelión frente a las figuras de autoridad, y e) probar nuevas cosas (sin miedo al exceso).
La calidad de la salud como consecuencia de la Medicina basada en la evidenci...Javier González de Dios
La presentación se desarrolla en cuatro apartados.
I. Aproximación a la CALIDAD EN SALUD
Se parte de la definición de la OMS (asegurar que cada paciente reciba el conjunto de servicios diagnósticos y terapéuticos más adecuado para conseguir una atención sanitaria óptima, teniendo en cuenta todos los factores y los conocimientos del paciente y del servicio médico, y lograr el mejor resultado con el mínimo riesgo de efectos iatrogénicos y la máxima satisfacción del paciente con el proceso) y se continúa profundizando en los tres niveles y nueve componentes de la calidad asistencial, influido por una importante variabilidad en la práctica clínica:
a) Gestión científico-técnica (la que más importa a los profesionales sanitarios): eficacia, seguridad y efectividad.
b) Gestión relacional-percibida (la que más importa a los pacientes o usuarios): información, aceptabilidad y satisfacción.
c) Gestión organizativo-económica (la que más importa a los gestores): equidad, accesibilidad y eficiencia.
II. Gestionar en busca de la (H)EXCELENCIA.
Con seis claves para ir en búsqueda del hospital "líquido" con profesionales "sólidos":
- Gestionar hacia la Medicina apropiada
- Gestionar en tiempo KISS
- Gestionar con (H)alma en busca de la (H)excelencia
- Gestionar con las 5C + 4 H
- Gestionar con método deliberativo
- Gestionar entre redes 2.0, 3.0 … y 4.0
III. Claves para sobrevivir a la MEDICINA BASADA EN LA EVIDENCIA… y no morir en el intento
Analizamos los cinco pasos de la MBE con el objetivo de aportar más ciencia al arte de la medicina:
- Primer paso: Pregunta clínica estructurada
- Segundo paso: Búsqueda bibliográfica sistematizada
- Tercer paso: Valoración crítica de documentos científicos
- Cuarto paso: Aplicabilidad en la práctica clínica
- Quinto paso: Adecuación de la evidencia científica a la práctica clínica
Y también revisamos los cinco malos usos y abusos que evitar en la MBE:
- No usar el nombre de la evidencia en vano
- No caer en el fundamentalismo metodológico
- Saber que hay vida más allá de PubMed… y Google
- Estar alerta a la evidence-biased medicine
- No minusvalorar la experiencia, lo que la medicina tiene de “arte y oficio”
IV. De la MEDICINA BASADA EN LA EVIDENCIA a la MEDICINA APROPIADA
Destacamos que el pasado reciente y el presente se ha vinculado a la MBE como herramienta para una práctica clínica que intenta resolver de la mejor forma posible la ecuación entre “lo deseable, lo posible y lo apropiado”, teniendo presente que la medicina es una ciencia sembrada de incertidumbre, variabilidad en la práctica clínica, sobrecarga de información, aumento de demanda y limitación de recursos.
Y que el presente y el futuro camina hacia la Medicina Apropiada, que es la conjunción de lo mejor de la Medicina basada en la evidencia (investigación) con los mejor de la Evidencia basada en la medicina (experiencia clínica).
Y este es el largo y sinuoso camino que cabe recoger para trabajar en ciencia y a conciencia por la calidad de la salu
El Plan Nacional sobre Drogas en colaboración con la Federación Española de Municipios y Provincias (FEMP) y el Instituto Europeo de Estudios en Prevención (IREFREA) nos presenta el informe “La prevención familiar de las adicciones”.
El propósito del informe de 104 páginas (que adjuntamos debajo) es explorar el estado de la prevención familiar en España para presentar recomendaciones que faciliten la transformación y la consolidación de la prevención familiar, a través de la revisión de bibliografía científica y documentos estratégicos, y por medio de entrevistas exploratorias con expertos.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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2. Oncology [7] and National Centre for Complementary and
Alternative Medicine [8] recommendations. Previous re-
search has indicated how MT can signifcantly impact the
emotional aspects of treatments, such as fear and anxiety, in
children with terminal cancer [9]. In this sense, the re-
lationship between music and emotions has been studied for
decades by researchers in the feld of MT, psychology, and
neuroscience, among other disciplines. Music moves us in
a very deep way [10] and emotional responses can appear
even after repeated exposure to music [11]. Although dif-
ferent studies on music and emotions have been carried out
over several decades [12], more recent work has started to
focus on the relationship between these two factors. For
example, functional neuroimaging studies of music and
emotion have shown that music can modulate activity in
brain structures known to be crucially involved in emotion
such as the amygdala, hypothalamus, hippocampus, insula,
nucleus accumbens, orbitofrontal cortex, and cingulate
cortex [13]. Given the efectiveness of MT, other studies have
shown how it helps reduce anxiety in children with cancer,
both when undergoing painful procedures and during the
process of their disease [14–17], as well as during radio-
therapy [18] and chemotherapy treatments [19, 20].
Other work indicates that MT helps children with cancer
to control their fear, anxiety, and pain when undergoing
bone marrow aspiration [21]. MT also helps them to release
fear and improves communication with families [22], fa-
cilitates positive experiences of emotions, and distracts
patients from fear or pain [23]. Hence, the scientifc evidence
available in the feld of MT applied to children with cancer
shows that emotional expression, among other parameters,
is vital both to patients and their families [24]. Finally, most
of these studies concluded that MT is an efective tool to
alleviate the negative efects of paediatric oncology treat-
ments. From the point of view of music therapists, there is
also the clinical perspective that singing, listening to music,
and improvisation can be useful for managing and
expressing emotions [25].
Other studies that analysed and/or explored the general
efects of MT in children with cancer in diferent phases of
stem cell transplantation [23, 26] found that MT can help
these patients to overcome their anguish, identify personal
strengths, disconnect from the situation, and improve re-
lationships with others, among other benefts. In addition,
research that evaluated physiological parameters showed
a reduction in heart rate [27]. Nonetheless, still very few
studies have addressed the efects of MTon the expression of
emotions in children with cancer [14, 17].
Terefore, the main objective of this current work was to
explore the emotional responses arising in children with
cancer and to transform these reactions using MT in-
terventions. We used the participatory action research
(PAR) approach as a methodological reference framework,
and recorded any emotional transformation present in our
participants after the MT sessions. Te PAR model was very
applicable to the research we wanted to conduct because it
includes the diferent stages patients must pass through
when experiencing the process of emotional change. More
specifcally, this type of change is achieved through
continuous feedback from all the diferent study phases,
allowing us to obtain positive results in terms of improving
the emotional states of our patients.
2. Methods
2.1. Research Design. Te epistemological approach of this
research meant that its character was sociocritical in nature.
Terefore, the voices of the participating children were
privileged in this research given that their voices not only
constituted their opinion but were also weighted with
emotional constructs within the context of their illness [28].
Te PAR method is most strongly linked to critical theory
because it seeks transformation through thoughtful action
and dialogue [29]. Tus, this qualitative study was based on
a PAR design, following the model by Susman and Evered
[30], which aims to record a process of analysis of the sit-
uation, identifcation of problems, and elaboration of
planned action strategies that are carried out and system-
atically submitted for observation, refection, and change,
which involves both the researchers and participants. Fig-
ure 1 explains the diferent phases of the PAR model used in
this study.
Te PAR not only proposes an approach, refection, and
criticism of the social reality of the context under in-
vestigation, but also requires a more inclusive research
process that allows the actions of its participants to promote
self-change, in which all of their potential is deployed, and
where each one of them enacts their own reality [31, 32]. Te
potential of PAR in the feld of health research is evident [33]
and so we considered it useful in the exploration and
transformation of emotional responses in children and
adolescents with cancer as mediated by MT. Tese fndings
could also perhaps help health professionals in their in-
teractions with children with cancer.
2.2. Research Methods. Tis research was conducted in fve
phases according to the PAR paradigm, as explained in
Figure 1. In the frst phase, a diagnosis was made in order to
make decisions about the study and justify the methodology
used. To achieve this, a scoping review on the use of MT in
paediatric oncology patients (both children and adolescents)
was carried out prior to the intervention [17]. Tis review
allowed us to note the psychoemotional needs identifed in
children with cancer as reported in the academic literature,
leading us to conclude that MT can ofer the possibility of
emotional transformation. In the second phase, action was
planned. First, we acquired approval for the study by the
Ethics Committee at the University of Alicante (Spain) and
the Paediatric Oncology and Haematology Unit team in the
General Hospital of Alicante (Spain). Ten, we held in-
formative meetings about the study with this aforemen-
tioned team of healthcare professionals, and jointly decided
upon the inclusion and exclusion criteria for the work.
In the third phase, we implemented the intervention in
the previously mentioned Paediatric Oncology and Hae-
matology Unit. Tis involved creating and performing the
MT sessions, including audio and video recording them,
2 European Journal of Cancer Care
3. followed by semistructured interviews with both the patients
and their parents. Tis was done during two data collection
periods (January to May 2020 and November 2021 to
February 2022), with the MT sessions being conducted
online in the second period. Constant assessment was
carried out by two researchers throughout this phase: the
frst author (an accredited music therapist) conducted the
MTsessions (65 individual MTsessions) with 27 patients. In
turn, the second researcher conducted the interviews with
the patients and their parents after each MT session and
during the sessions, made nonparticipant observations and
feld notes with subjective impressions and annotations in
a diary.
In the fourth phase, data evaluation was performed
during two analysis periods (June to September 2020 and
March to April 2022) by 4 researchers. To triangulate the
data, we used the following resources: (1) we conducted
interviews with the parents to validate the emotional states of
the patients; (2) we used data from the patients’ use of the
feelings thermometer before and after the MT intervention;
and (3) video recordings made of all the sessions which
allowed us to verify patient gestures and emotional ex-
pressions during the MT sessions. Finally, in the ffth phase,
the new knowledge obtained was categorised by defning
three main categories: (1) expression, (2) participation, and
(3) experiences. Showing positive results related to the
transformation of the patients’ emotions.
2.3. Sampling and Participants. Te participants were se-
lected through theoretical-intentional sampling [34]. Te
team of healthcare professionals at the Paediatric Oncology
and Haematology Unit at the General Hospital of Alicante,
Spain, provided data on the patients who were eligible to
participate in this study and in the MTsessions. A total of 30
children were invited to take part in this work, of which 27 of
them and their respective parents signed the informed
consent to participation; the three who did not sign their
consent declined because of their clinical status.
To defne the population under study in this research, we
considered the defnition of childhood given by the Con-
vention on the Rights of the Child, which defnes it as “every
human to the age of 18, unless, under the law of the State, he
has attained his age of majority earlier” [35]. Te inclusion
criteria included children with cancer aged between 6 and
18 years who voluntarily agreed to participate. Te exclusion
criteria included children with cancer who could not par-
ticipate in the study because of a physical or clinical problem
that prevented them from completing the proposed
activities.
2.4. Procedure. We used a range of techniques to collect and
analyse information in this work. Te data were collected
through (A) MTsessions in which children with cancer were
able to play musical instruments, sing, and improvise; these
interventions were the same in all the participants. (B)
Interviews carried out after each MT session with all the
patients (27 children) and their parents (23 parents). Te
interviews conducted with both the parents and the par-
ticipants lasted 10 to 15 minutes each. Te children par-
ticipated in semistructured interviews recorded on audio in
which they were asked questions about what had caused
them to sing, listen to songs, and play musical instruments.
Tey were also asked what that moment had been like for
them and how they felt about the activity. In addition, we
INTERVENTIONS
2nd phase: Action planning
- Approval by the Ethics Committee.
- Start of field work.
4th phase: Evaluation
- Data analysis.
1st phase: Diagnosis
- Decision making
- Methodological
5th phase: Definition of new
knowledge
3rd phase: Implementing the
intervention.
Scoping review (MT in paediatric and
adolescent oncological patients). Records
identified: 522. Articles included: 27.
Contact with gatekeepers and informants
(head of the Paediatrics service, Paediatric
Oncology team, and Pedagogical Unit
faculty members).
Two analysis periods (June to September
2020 and March to April 2022).
4 researchers.
Fieldwork.
Development and implementation of MT
sessions.
Three main study categories were
obtained. Participation in clinical sessions
at the hospital to present our results.
Detection of the psycho-emotional needs of
children with cancer.
Resources for triangulation (validation of
the emotional state of patients through
interviews with parents and use of a
‘feelings thermometer’ before and after the
MT intervention).
Obtaining positive results. Most of the
participants reported a transformation of
their emotions from negative to positive or
from positive to very positive.
Informative sessions with the Paediatric
Oncology team.
2 data collection periods (January to May
2020 and November 2021 to February
2022).
2 researchers.
27 patients.
65 individual MT sessions.
PLANNING
PHASES
Figure 1: Study scheme of the cyclical process of research and action (Susman and Evered [30], adapted for this study). MT �music therapy.
European Journal of Cancer Care 3
4. asked if they would like to do something else in the MT
sessions such as compose songs and play other musical
instruments.
We also conducted semistructured audio-recorded in-
terviews with the parents in order to triangulate all the
information collected. Tese were completed to understand
their perception about how singing, listening to songs, and
playing musical instruments had afected their children and
their opinions on the experiences of their children. Fur-
thermore, we asked the parents if they would add anything
else to the MT sessions. (C) Given that this work was based
on the PAR fundamentals, we used a ‘feelings
thermometer’—a visual tool from the Ofce of Children’s
Mental Health [36] consisting of fve images (anger, frus-
tration, worry, sadness, and joy), which is provided in annex
I. Each child was given a copy of this instrument so that they
could point out how they were feeling both before and after
the session. Tis allowed us to corroborate our observations
and obtain results about the emotional transformation ex-
perienced by each participant. In order to validate the
emotional transformation process, we also made video re-
cordings of the MT sessions. We were able to extract some
image captures from the videos that also allowed us to vi-
sually verify the changes in emotions experienced by the
children before and after the MT sessions (Figure 2).
2.5. Music Terapy Intervention. Given that we were con-
ducting MT interventions, to improve the transparency and
specifcity of the notifcations of the interventions and to
adequately understand and interpret the study results, all of
the data and MT session reports were recorded according to
the proposal from Robb et al. [37]. Te recommendations of
this proposal refer to seven diferent components of music-
based interventions: (A) intervention theory, (B) in-
tervention content, (C) intervention delivery schedule, (D)
interventionist, (E) treatment fdelity, (F) setting, and (G)
unit of delivery. In this study we used recreational, receptive,
and improvisational MT methods [38], which consisted of
playing percussion instruments, keyboard, improvising,
singing, and listening to songs, among others. Table 1 details
all the criteria for the MT interventions used in this study.
A total of 65 sessions were held in two periods, the frst
between January and May 2020 and the second from No-
vember 2021 to February 2022. Tey were all individual MT
sessions undertaken in the patient’s room or in the day
hospital. On average, the participating children received two
or three MT sessions each, 21 of which were held online.
Data saturation was reached around the beginning of the
second data collection period. However, to ensure the
quality of the study and our commitment to the participants,
we continued collecting data until the end.
2.6. Ethics. Te protocol of this study was approved by the
Ethics Committee at the University of Alicante, Spain
(reference: UA-2019-06-12). Te project was undertaken, at
all times, following the ethical principles set out in the
Declaration of Helsinki of 1975 and its 1983 amendments,
including the request for informed consent from all the
participants. In accordance with Spanish data protection
legislation (Organic Law 3/2018 on the Protection of Per-
sonal Data and Guarantee of Digital Rights), all the records
and corresponding informed consents to participation were
stored safely by the principal investigator and could only be
identifed by the assigned case number.
2.7. Data Analysis. Analysis of the transcribed interviews
and all the additional refections was completed through
a thematic analysis [41]. Te initial analysis was performed
by the frst author and encompassed three iterative phases:
(1) codes were created inductively to represent text seg-
ments, (2) similar codes were grouped into subcategories,
and (3) similar subcategories were grouped into categories.
We used MAXQDA software for this analysis. Te other
authors revised the initial analysis to check the validity and
qualitative reliability of the categories and subcategories [42]
by reading the interviews and results analysis to support or
extend the emerging fndings. Tis comparative analytical
process was continued until all authors accepted the rep-
resentation of the fndings. In addition, to guarantee the
quality of our study, we also considered the four aspects of
trustworthiness (credibility, dependability, confrmability,
and transferability) set out by Lincoln and Guba [43].
Te validity and reliability of the work were guaranteed
by data triangulation and saturation, using diferent tech-
niques to collect information and study data, conducting
interviews with children and parents, videotaping MT ses-
sions, using the emotion thermometer to directly and ver-
bally validate the data collected from the children, and by
recording the most signifcant facts in a feld diary, thereby
achieving a sufcient, dense description of the study phe-
nomenon. To promote the comfort of the participants, the
semistructured interviews were performed at the times and
places they suggested. Te children’s relatives provided
feedback on the data collected and continuous analyses were
planned. Once these data were collected, they were analysed
and returned to the hospital so that some of the areas could
be explored in more detail by conducting new MT sessions
[43, 44].
To maintain the credibility of our study, in addition to
the aforementioned points, we conducted a rigorous data
collection and analysis process. For example, the partici-
pants validated the emotional changes we had noted after
each MT session by using the emotions’ thermometer. Te
credibility of the data in this study was guaranteed by
continuously comparing it throughout the coding and
categorisation process and by including music therapists,
paediatricians, and researchers with experience in qualitative
studies in the research team performing the analyses [45].
Confrmability was maintained through the data coding and
interpretation by creating a record of all the data, allowing
for a clear audit process. In addition, the accuracy of the
analysis process was assured by asking several researchers
familiar with this qualitative research analysis method and
not participating in the study to verify the content of some of
the interviews and the extracted codes. Moreover, we also
considered the limitations of the research. Transferability
4 European Journal of Cancer Care
5. was ensured by providing a complete description of the
theme, as well as the characteristics of the participants and
examples of the children’s statements and expressions [46].
3. Results
Sociodemographic and clinical data about the participating
children were collected (Table 2), and in addition, socio-
demographic data about their parents were also collected
(Table 3). Te analysis gave rise to 25 codes with 8 sub-
categories and 3 categories (Table 4). Category 1 arose from
(a) the diferent emotional responses and changes and
increases in emotions in the children with cancer after MT,
(b) recognition of these emotions by their families, and (c)
the indirect benefts of MT sessions to families. In turn,
category 2 arose from (a) the participation of children with
cancer in MT sessions, (b) their musical tastes and pref-
erences, and (c) their interest in MT sessions. Finally,
category 3 arose from (a) the satisfaction of children with
cancer with the MT sessions and (b) the interactions be-
tween families, patients, and music therapists. Taken to-
gether, our research fndings indicated that the
interventions proposed by applying the PAR framework
gave rise to positive results. Te participating children
managed to transform their emotions and we verifed their
experiences of MT based on their own words and de-
scriptions. Likewise, the phases of the PAR plan helped us
to record our fndings. We showed that the resources of-
fered by MT benefted both children and their parents in
terms of greater well-being and quality of life during dif-
fcult times such as the hospitalisation period. Te eight
groups of subcategories were condensed into the three
categories described below.
3.1. Category 1: Expression. Children with cancer reported
that MT made it easier for them to express their emotions,
with changes and increases in emotion. Positive emotions
were present in all the MT sessions, where children with
cancer were able to sing, listen to music, improvise, and play
musical instruments, and they described these emotions in
the interviews. For example, a 10-year-old girl who par-
ticipated commented, “Listening to this song made me
happy,” a 12-year-old girl said, “I felt happy when I played
the percussion,” a 10-year-old girl commented, “Listening to
this song made me happy, and an 11-year-old boy said, “I
was very happy with the music.”
Te changes and increases in emotion were refected
both in the interviews conducted after each MT session and
through the feelings thermometer used before and after the
MT session interventions [36]. Te participants indicated
their emotional state through the thermometer before and
after the MT sessions. For instance, a 10-year-old girl
pointed to the “happy” image and after the session she
indicated that she was “super happy.” Another 11-year-old
girl pointed to the “angry” image before the session and the
“happy” image after the session. In addition, in the in-
terviews, the children with cancer described changes and
increases in emotion during the MT sessions. A 9-year-old
girl indicated, “before listening to the song I was sad, and
after listening to it I am happy,” a 13-year-old girl said, “I am
much better than before (the MT session),” a 7-year-old girl
commented, “before singing I was sadder, now (I’m) better,”
Figure 2: Te feelings thermometer used before and after the music therapy sessions. MT �music therapy.
European Journal of Cancer Care 5
6. a 17-year-old girl indicated, “listening to the songs bought
up many emotions and helped me with my illness,” and
a 6-year-old girl commented, “with music, I am super
happy.”
Te results of the parental recognition interviews with
the families also described the benefts of the MTsessions for
their children. A father of an 8-year-old boy said, “I noticed
that after the MT session there was a positive emotional
change in my son,” a father of a 10-year-old girl com-
mented, “after singing, the anger I had (felt) changed to
happiness,” a mother of a 12-year-old girl said, “she has
a lot of fun playing the percussion,” a mother of a 9-
year-old girl commented, “. . .she was sad and after lis-
tening to her favourite song, she became happy,” a mother
of a 14-year-old boy said, “this makes them happy. Tey
forget where they are (when in the MT sessions),” and
a mother of a 12-year-old girl said of her daughter, “before
listening to the songs, she was sad and after I saw that she
was happy.”
Te interviews with the parents also suggested that the
MTsessions had indirect benefts to families because parents
saw their children in an emotionally well state. A mother of
a 10-year-old girl commented, “she is usually sad, but when
she starts playing the piano here, she gets very excited, and
that makes me happy too.” A father of a 7-year-old girl said,
“after seeing her sad, to see her now happy after singing, it
makes me happy too.” A mother of a 6-year-old girl
commented, “I was very happy to see her improvise on the
piano.” A father of a 13-year-old boy said, “seeing him so
happy with music makes me cheer up too.”
By observing the videos of the MTsessions, we were able
to corroborate that during the sessions, the children con-
stantly showed changes in their facial expressions in relation
to their emotions, with expressions of joy at the end of the
interventions being constantly shown in all the images we
collected (Figure 3). Moreover, these gestures were com-
bined with verbalisation of the participant’s interest in each
of the proposed activities. Gestural expressions of
Table 1: Criteria for MT interventions.
A: Intervention Teory
In the past, MT has been used to ofer help to children cancer to reduce their anxiety, improve their self-esteem and social relationships, and
as a means of support to treat emotional factors related to their oncological treatment, among others
To date, very few studies have addressed the efects of MTon the expression of emotions in children with cancer. Terefore, in this work we
carried out MTsessions with the aim of opening channels of communication and emotional expression. We explored our results to try to
discover whether MT can help these patients express their emotions
B: Intervention Content
Previous research has revealed that children with cancer should have access to their preference of music as well as materials for making
music [39, 40]. In this work, both the music used for the singing and listening activities (musical pieces of pop, rock, classical, and deep
house styles, among others), and the musical instruments for performing live music were selected by the patients
Live music was performed by both the patient and music therapist while an mp3 player and a speaker were used to play the recorded music.
Te volume was controlled by the music therapist and the level ranged between 30 and 50 dB (decibels)
Percussion instruments were used in the improvisation activities (djembe, drum, bongo, woodblock, claves, tambourines, and body
percussion). A keyboard was also used. Te main improvisation method used was free improvisation. In addition to interacting with the
patient, the music therapist focused on sustaining the musical improvisations with the aim of welcoming musical improvisations by the
patients so that they could have the possibility of freely expressing their emotions
C: Intervention Delivery Schedule
A total of 65 sessions were held with a frequency of once a week between January and May, 2020, and November 2021 and February 2022;
27 sessions were conducted in patient rooms in the hospital, 17 sessions were carried out in the day hospital, and 21 sessions were
implemented online; 16 patients received 2 sessions, and 11 received 3 sessions. Each session lasted between 30 and 45 minutes
D: Interventionist
Te interventions were conducted by a qualifed music therapist (frst author) with the collaboration of the second author
E: Treatment Fidelity
Treatment adherence was guaranteed in every session because the protocols of each completed activity (singing, listening to music, musical
improvisation, and playing musical instruments, among others) was correctly followed, adapting the session to each patient. After each
session, the video recordings of the work were analysed to discover more about the details of the session. In addition, the music therapist
that led the sessions has had a long professional career as a musician
F: Setting
Because the sessions completed in the patients’ rooms were individual, they were sufciently private. Te ambient noise levels were low. Te
sessions that took place in the day hospital were also private because an additional room was requested in which we held the sessions
Te sessions carried out online were also private and were well accepted by the patients and were adapted to the most appropriate time for
the patient. We made some technical adaptations such as adjusting the delay when playing musical instruments online or altering the audio
quality during the sessions. We used diferent platforms, software, and tools to facilitate these adaptations
G: Unit of Delivery
All the sessions were carried out between the patient and the music therapist as individual sessions and the patient’s relatives were invited to
participate whenever the patient wanted them to
Robb SL, Carpenter JS, and Burns DS. Reporting guidelines for music-based interventions. J Health Psychol. 2011; 16(2):342-352. doi:
10.1177/1359105310374781 [37]
MT �music therapy.
6 European Journal of Cancer Care
7. abstraction were also observed, mainly when using im-
provisation methods. During the intervention, this allowed
us to verify that MT was beneftting them because these
gestures indicated that they had had to activate mechanisms
at a cognitive level, implying that they were inspired by the
songs and music and felt moments of hope, understood as
calm, within its process.
3.2. Category 2:Participation. Regarding participation in the
MT sessions, the children and adolescents with cancer were
able to express their preferences of both the musical pieces
(songs) and musical materials (musical instruments) that
would be used. We asked the participants about these two
aspects in the interviews, and one 13-year-old girl com-
mented, “I really like to improvise with percussion.” A 15-
year-old girl said, “with Adele’s song, I get excited to sing, it’s
one of my favourites.” Another 6-year-old girl commented,
“the piano is my favourite instrument, I like to play it.” A 17-
year-old girl commented, “the song Fool’s Overture by
Supertramp is one of my favourites.”
Children with cancer also described their interest in the
MT sessions; a 14-year-old boy indicated, “music is very
important to me.” Another 9-year-old girl said, “what we do
here with music is very good.” It seems that music and MT
could also refect the social and emotional development of
the patients. In other words, the connection with music
seemed to allow them to reinforce positive aspects of their
own personality, with the participants also reporting that the
music had had emotional benefts such as a release of energy,
hope, and companionship. A 17-year-old girl said, “music
ofers me diferent feelings, it allows me to release my energy
and it is my great companion.”
Te descriptions mentioned above indicate how MT is
a tool which requires the active participation of the re-
cipients. Te music in these spaces becomes a support
Table 2: Sociodemographic and clinical characteristics of the children and adolescents with cancer included in this work.
27 children with cancer
Ages, n (%)
6 years 1 (3.70%)
7 years 2 (7.40%)
8 years 3 (11.11%)
9 years 3 (11.11%)
10 years 5 (18.51%)
11 years 4 (14.81%)
12 years 2 (7.40%)
13 years 2 (7.40%)
14 years 2 (7.40%)
15 years 1 (3.70%)
16 years 1 (3.70%)
17 years 1 (3.70%)
Gender, n (%)
Male 12 (44.44%)
Female 15 (55.55%)
Diagnoses, n (%)
Acute lymphoblastic leukaemia B 8 (29.62%)
Acute myeloid leukaemia 4 (14.81%)
Ependymoma 4 (14.81%)
Ewing’s sarcoma 3 (11.11%)
Medulloblastoma 3 (11.11%)
Neuroblastoma 2 (7.40%)
Rhabdomyosarcoma 1 (3.70%)
Non-Hodgkin’s lymphoma 1 (3.70%)
Langerhans cell histiocytosis 1 (3.70%)
Place of residence, n (%) Alicante 27 (100%)
Table 3: Te sociodemographic characteristics of parents of
children with cancer.
23 parents
Ages, n (%)
28 years 1 (4.34%)
29 years 2 (8.69%)
30 years 3 (13.04%)
31 years 3 (13.04%)
34 years 6 (26.08%)
36 years 2 (8.69%)
37 years 3 (13.04%)
38 years 2 (8.69%)
39 years 1 (4.34%)
Sex, n (%)
Male 9 (39.13%)
Female 14 (60.86%)
Marital Status, n (%)
Married 21 (91.30%)
Separated 2 (8.69%)
Place of residence, n (%)
Alicante 23 (100%)
Educational level, n (%)
University graduate 12 (52.17%)
Secondary education 8 (34.78%)
Primary education 3 (13.04%)
Employment status, n (%)
Active employment 20 (86.95%)
Unemployed 3 (13.04%)
European Journal of Cancer Care 7
9. (a) (b)
(c) (d)
(e) (f)
Figure 3: Continued.
European Journal of Cancer Care 9
10. system that opens up channels of communication and en-
courages camaraderie between patients and their families, as
well as with the music therapist themselves.
3.3. Category 3: Experiences. Satisfaction with the MT ses-
sions was also described in the interviews by children with
cancer. In this sense, an 11-year-old girl commented, “I feel
good, and I have fun in this class with music,” a 16-year-old
boy indicated, “I really like to participate in these sessions,”
a 13-year-old girl said, “this experience with music is very
good,” a 17-year-old girl commented, “I have a lot of fun
improvising with percussion,” and another 15-year-old girl
indicated, “I feel a lot of freedom when I listen to songs in
these classes.”
Tere were constant interactions between families, pa-
tients, and the music therapist in the MT sessions. At all
times, the music therapist tried to connect and welcome the
patients through music to help them express their emotions
with confdence. Te participants mentioned this as, for
example, one 16-year-old boy commented, “I really like
playing the percussion with you (the music therapist).”
Similarly, an 8-year-old girl said, “when we play together
(with the music therapist) I concentrate more.” In addition,
the parents were also integrated into the sessions whenever
the patients wanted them to be, thereby creating a very
positive environment. An 11-year-old boy said, “I like
singing this Ed Sheeran song with my mum, it brings back
good memories.” A 7-year-old girl commented, “I like
seeing my dad play here with me, I like percussion.” An 11-
year-old boy said, “I like to sing the songs with my mum
and dad.”
All the children participating in this study said their
experiences of the MT sessions were positive because they
had allowed them to disconnect from their situation,
through interaction, for example, with musical in-
struments. Tis allowed them to have fun and improve
their well-being during the hospital stay. Likewise, in older
children, at a cognitive and emotional level, it helped them
to evoke positive memories and they recognised that they
were comfortable with their interactions with the music
therapist.
4. Discussion
Te objective of this study was to explore and transform the
emotional responses that may arise with the use of MT in
children with oncological pathologies. It is important to
consider that paediatric oncology patients sufer from
emotional disorders [47].
In this work, we showed that MT helps children with
cancer to express their emotions. In this sense, we could
compare this fnding with research conducted by a paedi-
atric Intensive Care Unit which aimed to involve patients in
making music to help them express their emotions and
construct interpersonal relationships [48]. Tis work
showed that MT positively infuenced the children’s states,
both physically and emotionally, thereby improving their
state of well-being. In the same way, a study by [49] con-
ducted in adult cancer patients found that MT sessions
helped patients with emotional expression, fun, creativity,
and symptom management.
Also of note, research by Ekman [39] indicated how
emotional expression arises involuntarily and emotions
provoked universal facial expressions. In our study, in our
analysis of the recorded videos of the MT sessions, we also
observed facial expressions of emotions in children which
seemed to indicate joy, as well as changes of emotion from
anger to joy and from sadness to joy, and in turn, an increase
in positive emotions such as joy.
Te emotional repercussions sufered by the families of
children with cancer have been widely demonstrated in the
academic literature [40]. Our current fndings also describe
the indirect benefts of MT interventions to families, in-
cluding an improvement in the emotional state of relatives.
Likewise, MTstudies in populations with cancer have widely
indicated the importance of these interventions because they
(g) (h)
Figure 3: Video captures of before and after music therapy sessions: (a) the active MT technique (before playing), (b) the active MT
technique (after playing), (c) the active MT technique (before playing), (d) the active MT technique (after playing), (e) the receptive MT
technique (before listening to music), (f) the receptive MTtechnique (after listening to music), (g) the active MTtechnique (before playing),
and (h) the active MT technique (before playing). MT �music therapy.
10 European Journal of Cancer Care
11. can positively impact the lives of both patients and families
[17, 18].
In our research, we found that the parents were satisfed
with the MT sessions conducted with their children, leading
them to provide positive responses in the interviews. Tey
indicated the emotional benefts they had noted in their
children during the MT sessions and said their children had
had a more positive attitude, had disconnected from their
clinical situation, paid more attention, and communicated
better with them after MT. Tese results are also consistent
with a study by Docherty et al. [50] that pointed out that
parents of adolescents with cancer described several emo-
tional benefts of MT in their children such as a decrease in
the symptoms of anguish, a greater sense of control, and
connection with others, among others.
In our study, the participants were ofered the possibility
of choosing their musical preferences in terms of both the
music and musical instruments used in the sessions, which
produced great participation and interest in the sessions as
a result. Of note, we found MT research in paediatric
oncology that had not given their participants the power to
choose the music used in the sessions, which we believe
may be the reason they did not obtain the expected benefts
similar to the ones we report here [16]. At the same time, O
´Callaghan et al. [51] and other authors such as Robb et al.
[52] have pointed out that children with cancer should have
access to the songs and musical instruments they prefer.
Te important value of music for children with cancer
was also evident in our study. In addition to the benefts in
terms of emotional well-being, music was able to help them
disconnect from their clinical situations and provide cog-
nitive and social support, among other benefts. Tese
fndings coincide with the meta-ethnography of Perkins
et al. [53], which concluded that music could support mental
well-being by satisfying individual needs, achieving this by
helping to manage and express emotions, facilitating per-
sonal development and connections with others, providing
respite, and helping to transport us to another place where
we can forget about worries.
Likewise, music and MTcan provide support to children
with cancer during adverse experiences, helping them with
the process of their disease [54]. In turn, MT was also able to
help adolescents with cancer cope with thoughts and be-
haviours related to their stage of maturity and development
[55]. It is noteworthy that the children with cancer said that
the MT sessions allowed them to have fun and provided
them with a sense of well-being within their emotional state.
Attempts were made to complete the MT sessions with
varied recreational, receptive, and improvisational methods
[38] consisting of singing, playing musical instruments, and
improvising, among others. Tis led to pleasant moments for
the patients. Other studies such as the one by Barry et al.
[56], which tried to create a MT CD (MTCD), have shown
that children with cancer experience MT sessions as at-
tractive and fun activities and experiences.
Te children interacted with the music therapist in all the
sessions, with the parents sometimes also joining in. Tis
interaction is important because the mission of music
therapists, among others, is to try to continuously connect
with patients and thus, allow them the possibility of
expressing their emotions through music. Te results of
previous studies such as the one by Uggla et al. [23] also
corroborate the vital importance of the patient-music
therapist interaction. Tis aforementioned study aimed to
explore how the participants and parents experienced the
interactive processes of MT interventions with oncological
children undergoing haematopoietic stem cell trans-
plantations. Tey demonstrated that the relationship be-
tween the patients and the music therapist favoured the well-
being of the family-child/adolescent binomial during their
hospital stay.
Regarding the administration of MT during the
COVID-19 pandemic, the study by Agres et al. [57] reported
that music therapists had various points of view about online
sessions. Tese included their lack of training to conduct
online sessions, with some highlighting that they preferred
face-to-face sessions, while others were in favour of online
MT sessions. In our study, we were able to carry out online
MT sessions without any major inconveniences. We made
some technical adaptations such as adjusting the delay when
playing musical instruments online or altering the quality of
the audio during the sessions. Tese adaptations that were
facilitated by the platforms, software, and tools we had
employed. In our experience, conducting the sessions online
at the height of the COVID-19 pandemic was interesting
because the patients could interact with us without having to
wear a mask, which made it easier for us to collect data from
their facial expressions.
Finally, by choosing to take a PAR approach to this
research, the children with cancer participated in their own
intervention. Tis allowed them to explore and transform
their emotions, helping them to create a desirable future in
which their emotional liberation was possible. It is also
important to note that cancer strongly impacts the emo-
tional, physical, and psychosocial well-being of children with
this disease [58]. Our fndings shed light on the possibilities
ofered by MT to help promote emotional expression among
paediatric cancer patients. Tis current work also suggests
the importance of MT to also favour the work of health
professionals and their relationships with patients.
4.1. Limitations and Strengths. Tis study focused on ex-
ploring and transforming the emotional responses of chil-
dren with cancer, with all of the MT sessions being carried
out at the individual level. Of note, the patients were also in
diferent phases of treatment and their ages were hetero-
geneous. Strength of the study may have been that we
measured the emotional state of the patients before and
after the intervention in all the MT sessions by employing
the feelings thermometer. In addition, recording the MT
sessions on video allowed us to extract themes and report
upon the most salient observations in this work. Interviews
were also conducted with the patients and their parents
immediately after each MT session, with another strength
of this research being that these data were obtained
simultaneously.
European Journal of Cancer Care 11
12. 4.2. Future Research. Although the fndings of this study
represent a useful report on the value of MT in the ex-
pression of emotions in children with cancer, it would be
interesting to carry out future research that specifcally
involves the perception of health professionals about the
experience of patients when they receive MT. In addition,
another future line of research would be to continue ex-
ploring how MT benefts the quality of life of patients, given
that it is a channel of communication and knowledge about
their emotional states which can favour interaction between
professionals and patients. It will also be important to
continue conducting research that can improve specifc MT
programmes, including the possibilities for online and face-
to-face interventions, in order to scale up MT interventions
in hospitals.
5. Conclusions
MT is an important component to help children with cancer
to express their emotions which also provides them with the
possibility of personal autonomy, and promotes self-
knowledge and transformation of their mood, thus im-
proving their quality of life. Teir parents can also indirectly
beneft from MT by observing emotional improvements in
their children after the MTsessions. It is noteworthy that the
children in this work could choose their favourite songs and
musical instruments, which facilitated their participation
and interest in the MT sessions.
Te application of the PAR approach in this research
allowed the eventual transformation of negative to positive
emotions in children, in whom we observed, for example,
a greater sense of joy and hope. Tis point is important
because oncological diseases can have substantial re-
percussions at the personal, family, social, and emotional
levels. Tese fndings also allowed us to propose future lines
of research, for example, with the aim of deepening this work
to discover how healthcare professionals would evaluate the
utility of MT and its applicability in complex environments
such as in the Paediatric Oncology Service. As in other
studies, we showed that the relationship between the music
therapist and children with cancer and their families during
MT sessions represents a means of support to help them
better cope with cancer.
Data Availability
Te data that support the fndings of this study are available
upon request from the corresponding author. Te data are
not publicly available because of privacy or ethical
restrictions.
Conflicts of Interest
Te authors declare that they have no conficts of interest.
Authors’ Contributions
R.R. contributed to methodology, was responsible for re-
search and data collection, performed formal analysis, and
prepared the original draft. A.N. prepared the original draft,
was responsible for data collection, reviewed and edited the
manuscript, was involved in study supervision, and per-
formed formal analysis. T.C. prepared the original draft, and
reviewed and edited the manuscript. M.C.S contributed to
methodology, performed formal analysis, was responsible
for data conservation, and was involved in study supervision.
A.G. conceptualised the study, contributed to methodology,
performed formal analysis, and reviewed and edited the
manuscript. J.G. conceptualised the study, and reviewed and
edited the manuscript.
Acknowledgments
Te authors wish to thank the children who participated in
this research. Te authors would also like to thank their
parents for their participation.
References
[1] W. H. O. G. Initiative and A. N. Overview, “WHO Global
Initiative for childhood cancer – India responds,” Pediatric
Hematology Oncology Journal, vol. 5, no. 4, pp. 145–150, 2020.
[2] C. G. Lam, S. C. Howard, E. Boufet, and K. Pritchard-Jones,
“Science and health for all children with cancer,” Science,
vol. 363, no. 6432, pp. 1182–1186, 2019.
[3] Z. J. Ward, J. M. Yeh, N. Bhakta, A. L. Frazier, and R. Atun,
“Estimating the total incidence of global childhood cancer:
a simulation-based analysis,” Te Lancet Oncology, vol. 20,
no. 4, pp. 483–493, 2019.
[4] K. Plummer, M. McCarthy, I. McKenzie, F. Newall, and
E. Manias, “Experiences of pain in hospitalized children
during hematopoietic stem cell transplantation therapy,”
Qualitative Health Research, vol. 31, no. 12, pp. 2247–2259,
2021.
[5] M. Van Schoors, J. De Mol, H. Morren, L. L. Verhofstadt,
L. Goubert, and H. Van Parys, “Parents’ perspectives of
changes within the family functioning after a pediatric cancer
diagnosis: a multi family member interview analysis,”
Qualitative Health Research, vol. 28, no. 8, pp. 1229–1241,
2018.
[6] J. Livesley and T. Long, “Children’s experiences as hospital in-
patients: voice, competence and work. Messages for nursing
from a critical ethnographic study,” International Journal of
Nursing Studies, vol. 50, no. 10, pp. 1292–1303, 2013.
[7] H. Greenlee, M. J. DuPont-Reyes, L. G. Balneaves et al.,
“Clinical practice guidelines on the evidence-based use of
integrative therapies during and after breast cancer treat-
ment,” CA: A Cancer Journal for Clinicians, vol. 67, no. 3,
pp. 194–232, 2017.
[8] N. C. C. I. H. Complementary, “Alternative, or integrative
health: what’s in a name,” National Center for Complementary
and Integrative Health, vol. 10, 2018.
[9] L. J. Duda, “Integrating music therapy into pediatric palliative
care,” Progress in Palliative Care, vol. 21, no. 2, pp. 65–77,
2013.
[10] P. Vuust, O. A. Heggli, K. J. Friston, and M. L. Kringelbach,
“Music in the brain,” Nature Reviews Neuroscience, vol. 23,
no. 5, pp. 287–305, 2022.
[11] P. Vuilleumier and W. Trost, “Music and emotions: from
enchantment to entrainment,” Annals of the New York
Academy of Sciences, vol. 1337, no. 1, pp. 212–222, 2015.
12 European Journal of Cancer Care
13. [12] A. C. North and D. J. Hargreaves, “Liking, arousal potential,
and the emotions expressed by music,” Scandinavian Journal
of Psychology, vol. 38, no. 1, pp. 45–53, 1997.
[13] S. Koelsch, “Brain correlates of music-evoked emotions,”
Nature Reviews Neuroscience, vol. 15, no. 3, pp. 170–180, 2014.
[14] M. Facchini and C. Ruini, “Te role of music therapy in the
treatment of children with cancer: a systematic review of
literature,” Complementary Terapies in Clinical Practice,
vol. 42, Article ID 101289, 2021.
[15] F. Giordano, B. Zanchi, F. De Leonardis et al., “Te infuence
of music therapy on preoperative anxiety in pediatric on-
cology patients undergoing invasive procedures,” Te Arts in
Psychotherapy, vol. 68, Article ID 101649, 2020.
[16] M. C. del Cabral-Gallo, A. O. Delgadillo-Hernández,
E. M. Flores-Herrera, and F. A. Sánchez-Zubieta, “Manejo de
la ansiedad en el paciente pediátrico oncológico y su cuidador
durante la hospitalización a través de musicoterapia,” Psi-
cooncologia (Pozuelo de Alarcon), vol.11, no. 2-3, pp. 243–258,
2014.
[17] R. C. Rodrı́guez-Rodrı́guez, A. Noreña-Peña, T. Chafer-
Bixquert, A. Lorenzo Vásquez, J. González de Dios, and
C. Solano Ruiz, “Te relevance of music therapy in paediatric
and adolescent cancer patients: a scoping review,” Global
Health Action, vol. 15, no. 1, Article ID 2116774, 2022.
[18] C. C. O’Callaghan, F. McDermott, P. Reid et al., “Music’s
relevance for people afected by cancer: a meta-ethnography
and implications for music therapists,” Journal of Music
Terapy, vol. 53, no. 4, pp. 398–429, 2016.
[19] S. Polat, A. Gürol, A. Çelebioğlu, and Z. K. Yildirim, “Te
efect of therapeutic music on anxiety in children with acute
lymphoblastic leukaemia,” Indian Journal of Traditional
Knowledge, vol. 14, no. 1, pp. 42–46, 2015.
[20] A. C. Sepúlveda-Vildósola, O. R. Herrera-Zaragoza,
L. Jaramillo-Villanueva, and A. Anaya-Segura, “Music as an
adjuvant treatment for anxiety in pediatric oncologic pa-
tients,” Revista Medica del Instituto Mexicano del Seguro
Social, vol. 52, no. Suppl 2, pp. S50–S54, 2014.
[21] I. N. da Silva Santa, M. C. Schveitzer, M. L. B. M. dos Santos,
R. Ghelman, and V. O. Filho, “Music interventions in pe-
diatric oncology: systematic review and meta-analysis,”
Complementary Terapies in Medicine, vol. 59, Article ID
102725, 2021.
[22] M. González-Martı́n-Moreno, E. M. Garrido-Ardila,
M. Jiménez-Palomares, G. Gonzalez-Medina, P. Oliva-Ruiz,
and J. Rodrı́guez-Mansilla, “Music-based interventions in
paediatric and adolescents oncology patients: a systematic
review,” Children, vol. 8, no. 2, p. 73, 2021.
[23] L. Uggla, K. Mårtenson Blom, L. O. Bonde, B. Gustafsson, and
B. Wrangsjö, “An explorative study of qualities in interactive
processes with children and their parents in music therapy
during and after pediatric hematopoietic stem cell trans-
plantation,” Medicine, vol. 6, no. 1, p. 28, 2019.
[24] B. Tucquet and M. Leung, “Music therapy services in pediatric
oncology: a national clinical practice review,” Journal of Pe-
diatric Oncology Nursing, vol. 31, no. 6, pp. 327–338, 2014.
[25] K. S. Moore, “A systematic review on the neural efects of
music on emotion regulation: implications for music therapy
practice,” Journal of Music Terapy, vol. 50, no. 3, pp. 198–
242, 2013.
[26] L. Uggla, L. O. Bonde, U. Hammar, B. Wrangsjö, and
B. Gustafsson, “Music therapy supported the health-related
quality of life for children undergoing haematopoietic stem
cell transplants,” Acta Paediatrica, vol. 107, no. 11,
pp. 1986–1994, 2018.
[27] L. Uggla, L. O. Bonde, B. M. Svahn, M. Remberger,
B. Wrangsjö, and B. Gustafsson, “Music therapy can lower the
heart rates of severely sick children,” Acta Paediatrica,
vol. 105, no. 10, pp. 1225–1230, 2016.
[28] A. Justo, D. Rincón, and A. A. Latorre, “Investigación edu-
cativa fundamentos y metodologı́as,” Labor, vol. 30, no. 2,
1992.
[29] W. Carr and S. Kemmis, Teoria critica de la ensenanza. La
investigación-acción del profesoradoMartinez Roca Barcelona,
Barcelona, Spain, 1986.
[30] G. I. Susman and R. D. Evered, “An assessment of the sci-
entifc merits of action research,” Administrative Science
Quarterly, vol. 23, no. 4, p. 582, 1978.
[31] E. A. M. Colmenares and M. Piñero, “La investigación acción
una herramienta metodológica heurı́stica para la
comprensión y transformación de realidades y prácticas
socio-educativas,” Redalyc, vol.14, no.1315-883X, pp. 96–114,
2008.
[32] E. Teram, C. L. Schachter, and C. A. Stalker, “Te case for
integrating grounded theory and participatory action re-
search: empowering clients to inform professional practice,”
Qualitative Health Research, vol. 15, no. 8, pp. 1129–1140,
2005.
[33] E. Abad Corpa, P. Delgado Hito, and J. Cabrero Garcı́a, “Una
forma de investigar en la práctica enfermera,” Investigación y
Educación en Enfermerı́a, vol. 28, no. 3, pp. 464–474, 2010.
[34] C. Conlon, V. Timonen, C. Elliott-O’Dare, S. O’Keefe, and
G. Foley, “Confused about theoretical sampling? Engaging
theoretical sampling in diverse grounded theory studies,”
Qualitative Health Research, vol. 30, no. 6, pp. 947–959, 2020.
[35] UN Committee on the Rights of the Child (CRC), General
Comment No. 7 (2005): Implementing Child Rights in Early
Childhood, 2006.
[36] OCMH Feelings Termometer, “Feelings thermometer,”
2022, https://children.wi.gov/Pages/FeelingsTermometer.
aspx.
[37] S. L. Robb, J. S. Carpenter, and D. S. Burns, “Reporting
guidelines for music-based interventions,” Journal of Health
Psychology, vol. 16, no. 2, pp. 342–352, 2011.
[38] H. Odell-Miller, A Comprehensive Guide to Music Terapy:
Teory, Clinical Practice, Research and Training, Jessica
Kingsley Publishers, England, United Kingdom, 2019.
[39] P. Ekman, El Rostro de La Emociones, RBA Libros, Barcelona,
Spain, 2017.
[40] J. A. Kearney, C. G. Salley, and A. C. Muriel, “Standards of
psychosocial care for parents of children with cancer,” Pe-
diatric Blood and Cancer, vol. 62, no. S5, pp. S632–S683, 2015.
[41] J. Corbin, A. Strauss, J. Corbin, and A. Strauss, Basics Of
Qualitative Research: Techniques and Procedures for De-
veloping Grounded Teory, SAGE, Tousand Oaks, CA, USA,
2008.
[42] S. C. Kitto, J. Chesters, and C. Grbich, “Qualiy in qualitative
research: criteria for authors and assessors in the submission
and assessment of qualitative research articles for the Medical
Journal of Australia,” Medical Journal of Australia, vol. 188,
no. 4, pp. 243–246, 2008.
[43] E. G. Guba and Y. S. Lincoln, “Competing paradigms in
qualitative research,” Handbook of Qualitative Research,
vol. 2, no. 105, pp. 163–194, 1994.
[44] A. Lucı́a Noreña, N. Alcaraz-Moreno, J. G. Rojas, and
D. Rebolledo-Malpica, “Applicability of the criteria of rigor
and Ethics in qualitative research,” vol. 12, 2012.
[45] L. S. Nowell, J. M. Norris, D. E. White, and N. J. Moules,
“Tematic analysis: striving to meet the trustworthiness
European Journal of Cancer Care 13
14. criteria,” International Journal of Qualitative Methods, vol. 16,
no. 1, Article ID 160940691773384, 2017.
[46] M. John Ravenek Candidate, D. Laliberte Rudman, and
O. Reg Associate Professor, “Bridging conceptions of quality
in moments of qualitative research,” International Journal of
Qualitative Methods, vol. 12, 2013.
[47] G. Zahed and F. Koohi, “Emotional and behavioral disorders
in pediatric cancer patients,” Iranian Journal of Child Neu-
rology, vol. 14, no. 1, pp. 113–121, 2020.
[48] L. Drake, F. Ben-Yelun, and M. J. Del Olmo, “Musicoterapia
en una UCI pediátrica: el uso de la música como emergente
emocional en el proceso de intervención con niños en sit-
uación de riesgo,” Revista de Investigación en Musicoterapia,
vol. 1, pp. 14–31, 2017.
[49] J. Bradt and C. Dileo, “Music interventions for mechanically
ventilated patients,” Cochrane Database of Systematic Reviews,
no. 12, Article ID CD006902, 2014.
[50] S. L. Docherty, S. L. Robb, C. Phillips-Salimi et al., “Parental
perspectives on a behavioral health music intervention for
adolescent/young adult resilience during cancer treatment:
report from the children’s oncology group,” Journal of Ad-
olescent Health, vol. 52, no. 2, pp. 170–178, 2013.
[51] C. O’Callaghan, B. Dun, A. Baron, and P. Barry, “Music’s
relevance for children with cancer: music therapists’ quali-
tative clinical data-mining research,” Social Work in Health
Care, vol. 52, no. 2-3, pp. 125–143, 2013.
[52] S. L. Robb, J. E. Haase, S. M. Perkins et al., “Pilot randomized
trial of active music engagement intervention parent delivery
for young children with cancer,” Journal of Pediatric Psy-
chology, vol. 42, no. 2, pp. 208–219, 2017.
[53] R. Perkins, A. Mason-Bertrand, D. Fancourt, L. Baxter, and
A. Williamon, “How participatory music engagement sup-
ports mental well-being: a meta-ethnography,” Qualitative
Health Research, vol. 30, no. 12, pp. 1924–1940, 2020.
[54] A. Coughtrey, A. Millington, S. Bennett et al., “Te efec-
tiveness of psychosocial interventions for psychological
outcomes in pediatric oncology: a systematic review,” Journal
of Pain and Symptom Management, vol. 55, no. 3, pp. 1004–
1017, 2018.
[55] S. N. Rodgers-Melnick, T. J. G. Pell, D. Lane et al., “Te efects
of music therapy on transition outcomes in adolescents and
young adults with sickle cell disease,” International Journal of
Adolescent Medicine and Health, vol. 31, no. 3, 2017.
[56] P. Barry, C. O’Callaghan, G. Wheeler, and D. Grocke, “Music
therapy CD creation for initial pediatric radiation therapy:
a mixed methods analysis,” Journal of Music Terapy, vol. 47,
no. 3, pp. 233–263, 2010.
[57] K. R. Agres, K. Foubert, and S. Sridhar, “Music therapy during
COVID-19: changes to the practice, use of technology, and
what to carry forward in the future,” Frontiers in Psychology,
vol. 12, pp. 647790–647817, 2021.
[58] R. M. Stubbs, “A review of attachment theory and internal
working models as relevant to music therapy with children
hospitalized for life threatening illness,” Te Arts in Psycho-
therapy, vol. 57, pp. 72–79, 2018.
14 European Journal of Cancer Care