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| 3. |
- Gabrielsson, Hanna, 1977-
(författare)
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Adults with Spina bifida : voices from everyday life and exploration of living conditions
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to generate knowledge about living with Spina bifida, by mapping the condition and together with the adults with Spina bifida explore their living conditions and experiences in everyday life. Methods Study I was a quantitative study with a cross-sectional design. In Study II, individual experiences of daily life were explored by deep interviews using a reflective lifeworld approach. Study III had a participatory approach including five members of a photovoice group who met for eight sessions. Photographs taken by the members served as a starting point for the dialogue about what was of interest in their daily life. A narrative analysis was conducted by the researchers, incorporating the analysis the group did together. Study IV focused on alignment with the methodology in which photovoice is grounded. By returning to the ideological cornerstones of photovoice, the empirical experiences from Study III and examples from the literature were elaborated through processes within photovoice. The findings show that those adults with Spina bifida who were >46 years old had less complex medical conditions and better physical and cognitive functions, and had attained a higher level of education. The main theme in Study II was presented as “The contradictory path towards wellbeing in daily life.” In Study III, the members’ experiences in everyday life showed that many solutions offered by society were “An adaptation for us, but it works for no one.” The findings are further presented under three themes: “Accessibility – a never-ending project,” “Tensions of a normative view” and “Power to influence.” By focusing on action and narrative in Study IV, it is shown that dialogue, action, and interaction are important aspects of using photovoice. In conclusion, not all adult persons receive the support they need in everyday life, something future generations of adult persons with Spina bifida may have a higher need for. The stories and experiences of adults with Spina bifida in this thesis paint a history of not being asked, concerning their own situation. This shows that there is insufficient integration of the persons’ experiences in society’s efforts to plan for, and support, these individuals. The photovoice method was feasible for this group, providing opportunity for being part of dialogue, action, and interaction.
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| 5. |
- Dahlberg, Karuna, 1979-
(författare)
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e-Assessed follow-up of postoperative recovery : developement, evaluation and patient experiences
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The majority of all surgeries are performed as day surgery. After discharge, patients are expected to take responsibility for their postoperative recovery themselves. Recovery Assessment by Phone Points (RAPP) is an e-assessment developed for assessing and providing follow-up on postoperative recovery, which includes the Swedish web-version of the Quality of Recovery questionnaire (SwQoR). It also enables the patient to get in contact with the day surgery unit. The overall aim of this thesis was to further develop and evaluate a systematic follow-up of postoperative recovery using a mobile app in adult persons undergoing day surgery, as well as to describe their experiences of postoperative recovery when using the mobile app. Study I: This study included three steps. Equivalence testing between the paper and app versions of the SwQoR showed agreement (n=69). The feasibility and acceptability evaluation showed that participants (n=63) were positive towards using a mobile phone application during postoperative recovery. Content validity of the SwQoR reduced the original 31 items to 24. Studies II and III: A multicentre, two-group, parallel, single-blind randomized controlled trial including 997 participants was conducted to investigate the effect of e-assessment on postoperative recovery (II) and cost-effectiveness (III) in a RAPP group compared with a control group. The RAPP group reported significantly better quality of postoperative recovery on postoperative days 7 and 14 compared with the control group. Moreover, RAPP may be cost-effective as it provides low-cost care. Study IV: Explored experience of postoperative recovery in participants using a mobile phone app during their postoperative recovery. Qualitative inductive semi-structured interviews (n=18) were performed. Findings showed that feeling safe is important during postoperative recovery. This feeling can be created by patients themselves, but sufficient support and information from health care and next of kin is needed. Overall, this thesis showed positive results for RAPP, suggesting that RAPP is a solution that may benefit patients after day surgery.
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| 6. |
- Poikonen, Hanna, et al.
(författare)
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InMotion – Mixed physical exercise with creative movement as an intervention for people with schizophrenia
- 2023
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Konferensbidrag (refereegranskat)abstract
- Schizophrenia (SCZ) is among the world’s top ten causes of long-term disability (World Health Organization, 2004). The major symptoms of SCZ include hallucinations, delusions, affective flattening, and cognitive impairment, and their treatment with antipsychotic medications is far from optimal.Creative and body awareness training (dance/movement therapy, body psychotherapy) and physical training (aerobic and strength training) improve SCZ symptoms (e.g Martin et al., 2016, 2017; Girdler et al., 2019; Millman et a., 2021). In our novel intervention, we bring together creativity and self-awareness with physical training. The 12-week 24-session intervention with 30 participants (Figure 1) includes components like visualization, cardio and strength training, and social interaction. We will measure the impact with standardized clinical questionnaires, EEG-fNIRS, motion capture, and cognitive, affective, and physical tests. We expect our intervention to improve the quality of life and negative symptoms of SCZ by balancing the brain functions and bodily state related to self-awareness, social interaction, and physical fitness. In my talk, I will cover brain dysfunctions related to self-awareness in SCZ (Ferri et al., 2012; Ebisch et al., 2013) and describe the scientific rationale for each component included in our novel intervention (e.g. Lee et al., 2015; Firth et al., 2017).
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| 7. |
- Poikonen, Hanna, et al.
(författare)
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“InMotion”—Mixed physical exercise program with creative movement as an intervention for adults with schizophrenia : study protocol for a randomized controlled trial
- 2023
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Ingår i: Frontiers in Human Neuroscience. - : Frontiers Media S.A.. - 1662-5161. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- Background: Schizophrenia is among the world’s top 10 causes of long-term disability with symptoms that lead to major problems in social and occupational functioning, and in self-care. Therefore, it is important to investigate the efficacy of complementary treatment options for conventionally used antipsychotic medication, such as physical training, and psychosocial interventions.Objective: To combine aerobic and strength training with cognitive, emotional and social stimulation in one intervention for people with schizophrenia and test the feasibility and effects of this intervention.Methods: The study is a mixed-method randomized controlled trial to evaluate the effects of a 12-week intervention for adults with schizophrenia. The treatment group (30 participants) will receive the intervention in addition to standard care and the control group (30 participants) only standard care. The intervention consists of 24 biweekly sessions with a duration of 60 min. The pre-test (weeks from 4 to 2 prior to the intervention) and post-test (week 12) include clinical measure (PANSS), quality of life, social performance, movement quantity, brain function and eye tracking measures. In addition, a treatment subgroup of 12–15 participants and their family member or other next of kin will complete a qualitative interview as a part of their post-test. Two follow-up tests, including clinical, quality of life, brain function and eye tracking will be made at 6 and 12 months from the completion of the intervention to both study groups. The primary outcome is change in negative symptoms. Secondary outcome measures include general and positive symptoms, quality of life, social performance, movement quantity, brain function and eye tracking. Explorative outcome includes patient and family member or other next of kin interview.Results: Pilot data was collected by June 2023 and the main data collection will begin in September 2023. The final follow-up is anticipated to be completed by 2026.Conclusion: The InMotion study will provide new knowledge on the feasibility, efficacy, and experiences of a novel intervention for adults with schizophrenia. The hypothesis is that regular participation in the intervention will reduce clinical symptoms, normalize physiological measures such as brain activation, and contribute to new active habits for the participants.
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| 8. |
- Ullsten, Alexandra, 1967-
(författare)
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Singing, sharing, soothing : Family-centred music therapy during painful procedures in neonatal care
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- To sing is to communicate. The soothing, comforting and emotional regulating properties of a lullaby are well-known cross-culturally and historically. This doctoral thesis addresses neonatal pain management from a novel and groundbreaking perspective, studying the efficacy of live music therapy on infants’ pain responses during venepuncture. New research is needed to advance the non-pharmacological interventions in neonatal pain care, and neonatal music therapy (NICU MT) offers active methods to involve the parents in pain management. The doctoral thesis includes two empirical and two theoretical articles. In paper I, preterm and term infants (n=38) were subjected to venepuncture with and without live lullaby singing, in a randomised order with a crossover design. Parent-preferred lullabies were performed live by a music therapy student and standard care was provided for all infants. The results did not show any significant pain-alleviating effects, however, the live singing was not stressful for the infants.In paper II, the microanalysis disclosed that live lullaby singing is a communicative reciprocal intervention that also applies to premature infants during painful procedures. Live lullaby singing is a tool suitable as a means to optimise the homeostatic mechanisms. The results from the theoretical papers III and IV are further developed and synthesised in the thesis into a theoretical strategy; The Nordic NICU MT pain management strategy, featuring the parents and their singing voices as mediators for pain relief. The role of the music therapist in neonatal pain management is as a facilitator and an educator for the parents. Coaching parents to better meet their infant’s attachment needs during a painful procedure may lead to more efficacious interventions. The biopsychosocial parental infant-directed singing is presumably an applicable parent-driven non-pharmacological intervention, which promotes pain relief and attachment formation during painful procedures. Neonatal music therapy is still in its infancy in the Nordic countries, but the societal and healthcare contexts afford important prerequisites to further develop NICU MT as a truly family-centred approach. This doctoral thesis will hopefully contribute to the important interdisciplinary endeavour worldwide of involving and integrating parents in neonatal pain management.
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| 9. |
- Johansson, Sara, et al.
(författare)
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Nytt forskningsprojekt om medicinsk häfta
- 2023
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Ingår i: Sårjournalen. - : Sårsjuksköterskor i Sverige. - 2003-8054. ; :1, s. 12-12
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Forskningsöversikt (populärvet., debatt m.m.)
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| 10. |
- Nilsson, Ulrica, 1960-, et al.
(författare)
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Psychometric evaluation of the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery and postoperative behavior and recovery inchildren undergoing tonsil surgery
- 2019
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Ingår i: Journal of Perioperative Practice. - : Harrogate : Association for Perioperative Practice. - 1750-4589 .- 2515-7949. ; 29:4, s. 94-101
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Tidskriftsartikel (refereegranskat)abstract
- The study comprised a prospective, comparative cross-sectional survey in 143 (of 390) children undergoing tonsil surgery. Parents answered the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS), and children answered the questionnaire Postoperative Recovery in Children (PRiC). The PHBQ-AS had positive correlation with the PRiC and with general health. On day 10 after surgery, up to one-third of the children still reported physical symptoms (PRiC). No gender or age differences concerning the items of behavior (PHBQ-AS) were found. The quality of postoperative recovery (PRiC) in girls was lower, with higher levels of nausea, dizziness, coldness, and headache compared to the boys. Children <6 years of age reported higher levels of dizziness and lower sleep quality and lower general health.
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| 11. |
- Svanberg, Mikael, 1958-
(författare)
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Psykologiska faktorer vid rehabilitering av patienter med långvarig smärta
- 2022
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Chronic pain is common and a burden for both the individual and society. In chronic pain, the pain has lost its function as a warning system and instead has become a disease in itself. Neurobiologically, several areas of the brain are involved, but to gain a broader understanding of the long-term pain, the biopsychosocial model is the best starting point. In line with thisand many scientific studies since the late 90's, psychological factors have proven to be an important factor in the development and maintenance of chronic pain. Interdisciplinary multimodal rehabilitation programs (IMMRP) are the treatment currently given to patients with long-term pain in the specialized pain rehabilitation. When the IMMRP has been reviewed, patients have shown improvement over time, but it is not possible to say whether it is the IMMRP or which parts of the IMMRP that explain the improvement (1).In this licentiate thesis, I have studied the importance of psychological factors in the rehabilitation of patients with chronic pain. This has been done in three studies reported in three published articles. All the studies have been close to the clinic and have been performed on patients in the specialized pain rehabilitation care in Sweden.The first article studied the effect of the multimodal investigation (MMI). More specifically, it was investigated whether alliance building and feelings of validation in patients with chronic pain affected their acceptance of pain, pain management, catastrophic thoughts, and depression. This was performed in a "single case" study on six patients in MMI. The results showed that despite good alliance and sense of validation, acceptance increased only in one patient and no improvement was seen in pain management, catastrophizing, and depression.In study two, subgroups of patients with chronic pain were studied. The subgroup analysis showed that patients referred for IMMRP could be divided into groups with different profiles regarding emotional problems and pain avoidance. These profiles were important for how the patients relatedto their pain and the results of IMMRP. The results of the study can increase the understanding of which patients should be selected for IMMRP and how the treatment can be adapted to the patients' needs.In study three, opioid treatment in patients with long-term pain who were referred to IMMRP was studied. The result showed that opioid prescribing was common and 55% of the participants received at least one prescription for opioids during the two years after the first assessment. It also turns out that there was a connection between individual patient characteristics (especially pain and depressive symptoms) and opioid prescription. Understanding how individual patient characteristics relate to prescribing patterns and long-term opioid use is an important prerequisite for managing opioid prescribing and the basics for preventing overuse. Overall, this licentiate thesis shows that MMU has no therapeutic effect on patients with long-term pain. It also shows that patients with chronic pain are a heterogeneous group that can be divided into subgroups based on psychological characteristics. The subgroups, in turn, had different ways of managing their pain and absorbing the treatment offered. In addition, it emerged that opioid prescribing was common among patients with long-term pain and that there was a link between opioids and patient characteristics.
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| 13. |
- Torsy, Tim, et al.
(författare)
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Accuracy of the corrected nose-earlobe-xiphoid distance formula for determining nasogastric feeding tube insertion length in intensive care unit patients : A prospective observational study
- 2020
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Ingår i: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 110
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Tidskriftsartikel (refereegranskat)abstract
- Background: As nasogastric feeding tube insertion is a frequently applied, non-risk-free nursing technique, a high level of evidence-based nursing care is required. Little evidence is available regarding the accurate determination of the insertion length of nasogastric feeding tubes. The method of using the nose-earlobe-xiphoid distance as measurement is inadequate and not supported by evidence. Findings from a recent randomized trial led to an alternative calculation: the corrected nose-earlobe-xiphoid distance formula: (nose-earlobe-xiphoid distance × 0.38696) + 30.37 + 6 cm.Objectives: To test the accuracy of the corrected nose-earlobe-xiphoid distance formula for determining the required nasogastric feeding tube insertion length in adults admitted on an intensive care unit and to investigate the probability to successfully obtain gastric aspirate for pH measurement.Design: Prospective, single‐centre observational study.Participants and methods: Adult intensive care unit patients in a general hospital (N=218) needing a small-bore nasogastric feeding tube were included between March and September 2018. Correct tip positioning was defined as a tube tip located > 3 cm under the lower esophageal sphincter. Tip positioning was verified using X-ray.Results: All nasogastric feeding tube tips were correctly positioned > 3 cm under the lower esophageal sphincter. The chance of successfully obtaining gastric aspirate within 2 hours after placement of the tube was 77.9%.Conclusions: With all tips positioned > 3 cm in the stomach and zero tubes migrating back into the oesophagus, the corrected nose-earlobe-xiphoid distance formula can be considered a more accurate method to determine nasogastric feeding tube insertion length.
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| 14. |
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| 15. |
- Torsy, Tim, et al.
(författare)
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Factors associated with insufficient nasogastric tube visibility on X-ray : a retrospective analysis
- 2021
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Ingår i: European Radiology. - : Springer. - 0938-7994 .- 1432-1084. ; 31:4, s. 2444-2450
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Chest X-ray imaging is frequently used for verifying the position of a blindly inserted nasogastric tube. A high-quality X-ray increases the likelihood of conclusive visibility of tube tip positioning, thus avoiding risks due to a misplaced tube (e.g., pulmonary intubation, pneumothorax, small bowel insertion). Therefore, this study aims to determine patient-related and environmental factors affecting the visibility of nasogastric tubes on X-ray in adults.Methods: A retrospective descriptive analysis of routinely collected clinical datawas performed on all included patients (N = 215) from a prospective randomized trial in a general hospital. A chest X-ray was taken of each patient needing a nasogastric feeding tube, after which visibility and positioning of the tube on X-ray was independently evaluated by 3 radiologists.Results: In 14.9% (n = 32) of all patients, image quality was insufficient, so no conclusive visibility of nasogastric tube positioning could be found. A patient-related predictor regression model (sex, age, body mass index) explained 21% of variance for an insufficient visibility of the nasogastric tube (Nagelkerke R2 = 0.21). An environmental factor regression model demonstrates a guidewire being inside the tube or not during X-ray as a predictor for a conclusive visibility on X-ray.Conclusions: High body mass index, male sex, and the absence of a guidewire inside the nasogastric tube at the time of chest Xray are associated with a risk of insufficient visibility of the tube on X-ray. Patient profiles can be defined in which supplementary attention is needed when obtaining chest X-rays whose purpose is to confirm nasogastric tube positioning.
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| 16. |
- Torsy, Tim, et al.
(författare)
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The accuracy of methods for determining the internal length of a nasogastric tube in adult patients : A systematic review
- 2022
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Ingår i: American Journal of Clinical Nutrition. - : Oxford University Press. - 0002-9165 .- 1938-3207. ; 116:3, s. 798-811
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: Blind insertion of nasogastric tubes is performed for several reasons: Nutrition and medication administration, gastric aspiration/decompression, and other, diagnostic reasons. Accidental intraesophageal and intestinal placement is common, and increases the risk of serious complications. Therefore, accurate determination of the internal length of the nasogastric tube prior to placement is considered a prerequisite for achieving correct gastric positioning.OBJECTIVES: To identify, assess and summarize the evidence on the accuracy of methods for determining the internal length of a nasogastric tube in adults.METHODS: Cochrane Library, EMBASE, PubMed, CINAHL, and Web of Science were searched up to January 31, 2022. Studies were eligible when reporting data on the accuracy of methods for determining internal nasogastric tube length in adults. Study selection, risk-of-bias assessment, and data extraction were performed independently by two investigators. Risk-of-bias was assessed using the Cochrane Risk-of-Bias Tool and the JBI Critical Appraisal Checklist for Cross Sectional Studies. A narrative synthesis of the results was then conducted.RESULTS: Twelve papers were included in this review. All studies were observational, cross-sectional in nature, except for one RCT. Ten methods for determining the internal length of a nasogastric tube were described. Correctly positioned NG tubes ranged from 13% to 99%. Results showed that the nose-earlobe-xiphoid (NEX) distance + 10 cm (M = 59.9 - 60.7 cm) and (NEX x 0.38696) + 30.37 + 6 cm (M = 56.6 - 56.7 cm) could potentially result in accuracy as high as 97.4 and 99.0%, respectively.CONCLUSIONS: Current data do not provide conclusive evidence of 100% accuracy in finding a correctly placed nasogastric tube when using a method for determining the internal length. Blind placement, using any of the documented methods, cannot be considered safe without additional verification of tube tip positioning. Furthermore, using any of these ten methods does not reduce the risk of pulmonary intubation.
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| 17. |
- Ullsten, Alexandra, 1967-, et al.
(författare)
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Efficacy of Live Lullaby Singing During Procedural Pain in Preterm and Term Neonates
- 2017
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Konferensbidrag (refereegranskat)abstract
- Background: Acute and repeated pain has long-term negative impact on infants’ development and future behaviour. The use of analgesic drugs has negative side-effects, which emphasizes the need for complementary approaches to pain management.Aim: This study is the first clinical trial measuring if live lullaby singing can influence behavioural and physiological pain responses during venepuncture in preterm and term neonates.Method: Preterm and term infants (n=38) were subjected to venepuncture with and without live lullaby singing, in a randomised order with a cross over design. Parent-preferred lullabies were performed live and standard care was provided for all neonates. Behavioural and physiological pain responses were assessed.Results: The live lullaby singing did not show a statistically significant effect on the infants’ pain score. There was a significantly calmer breathing pattern in the lullaby intervention versus the control condition in the pre-needle stage. There were non-significant indications of fewer and shorter skin punctures with lullaby singing.Conclusions: The additive effect of live lullaby singing has not been shown to alleviate infants’ behavioural pain responses during venepuncture; however nor has it been shown to be harmful. More research is needed to explore the potential benefits of music therapy including the role of the parents.
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| 18. |
- Ullsten, Alexandra, 1967-, et al.
(författare)
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Efficacy of Live Lullaby Singing During Procedural Pain in Preterm and Term Neonates
- 2017
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Ingår i: Music and Medicine. - : PKP Publishing Services. - 1943-8621 .- 1943-863X. ; 9:2, s. 73-85
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Tidskriftsartikel (refereegranskat)abstract
- This clinical trial tested the pain relieving effect of live lullaby singing on behavioral and physiological pain responses during venepuncture in 38 preterm and full term neonates. Acute and repeated pain, as well as the use of analgesic drugs, may have long-term negative impact on infants’ development and future behaviour. This emphasizes the need for complementary approaches to pain management such as music therapy.Parent-preferred lullabies were performed live and standard care was provided for all neonates. Behavioral responses with regard to pain were assessed with Premature Infant Pain Profile-Revised (PIPP-R) and Behavioral Indicators of Infant Pain (BIIP). Heart rate, respiratory rate and oxygen saturation were measured each tenth second.Although the live lullaby singing did not show a statistically significant effect on the infants’ pain score, there was a significantly calmer breathing pattern in the lullaby intervention versus the control condition in the pre-needle stage, showing a non-significant trend towards higher oxygen saturation levels and calmer heart rate in the lullaby intervention versus the control condition in the pre-needle stage. There were non-significant indications of fewer and shorter skin punctures with lullaby singing. More research is needed to explore such positive trends in the data.
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| 19. |
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| 20. |
- Ullsten, Alexandra, 1967-, et al.
(författare)
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Family-centred music therapy during painful procedures in neonatal care
- 2018
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Konferensbidrag (refereegranskat)abstract
- Background: During the most vulnerable period in a child’s life, preterm and sick newborns are exposed to a high number of painful procedures, sometimes without the comfort of their parents. Repeated pain and frequent use of opioids can have consequences for the neurological and behaviour-oriented development of the infant.It is vital to identify a repertoire of effective non-pharmacological interventions.Method: Preterm and term infants (n=38) were subjected to venepuncture with and without live lullaby singing, in a randomised order with a cross over design. Parent-preferred lullabies were performed live by a music therapy student. Standard care (facilitated tucking and oral glucose) was provided for all neonates. Behavioural and physiological pain responses were assessed.Results: Live singing with newborn infants is a social communicative interaction. If the vocal performance is predictable and regular from start, it may optimize homeostasis during painful procedures. However, the live lullaby singing did not show a statistically significant effect on the infants' pain score. There was a significantly calmer breathing pattern in the lullaby intervention versus the control condition in the pre-needle stage. There were non-significant indications of fewer and shorter skin punctures with lullaby singing.Conclusion: The additive effect of live lullaby singing has not been shown to alleviate infants’ behavioural pain responses during venepuncture; nor has it been shown to be stressful. Pain involves the interaction of biopsychosocial and situational factors, therefore more research is needed to explore the potential benefits of music therapy including the role of the parents.
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| 21. |
- Ullsten, Alexandra, 1967-, et al.
(författare)
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Live lullaby singing during painful procedures in preterm and term infants
- 2019
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Konferensbidrag (refereegranskat)abstract
- Introduction: Infant-directed singing is a medium for parents and infants to communicate in a mutual relationship. Infant-directed singing is a multisensory biopsychosocial communication that also applies to ill and vulnerable hospitalised infants. The first Nordic implementation process of family-centred neonatal music therapy started in Sweden at the Central Hospital in Karlstad by the first author in March 2010 (Fig. 1). Live lullaby singing during painful procedures is the first clinical trial to measure the pain-relieving effects of live lullaby singing during venepuncture in preterm and term neonates.Method: 38 infants were subjected to venepuncture with and without live lullaby singing, in a randomised order with a cross over design. Parent-preferred lullabies were performed live by a music therapy student and standard care (facilitated tucking and oral glucose) was provided for all infants. Behavioural and physiological pain responses were assessed. The data from the RCT was analysed with qualitative and quantitative methods.Results: During the lullaby procedures the physiological patterns were more stable and regular. Lullaby singing significantly calmed the infants’ respiration before venepuncture (Fig. 2). There were nonsignificant indications of fewer and shorter skin punctures with lullaby singing. The behavioural pain responses did not show any significant differences between the live lullaby singing and standard care procedures, however, nor did they indicate that live lullaby singing was harmful or stressful.Conclusion: Live singing with infants is a biopsychosocial communicative interaction. A music therapist specialised in family-centred neonatal music therapy methods can mentor parents how to use live lullaby singing in connection to painful procedures. More research is needed to explore the potential benefits of family-centred music therapy as procedural support including the voice of the parents.
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| 22. |
- Ullsten, Alexandra, 1967-, et al.
(författare)
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Singing, sharing, soothing : Biopsychosocial rationales for parental infant directed singing in neonatal pain management: A theoretical approach
- 2018
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Ingår i: Music & Science. - : Sage Publications. - 2059-2043. ; 1, s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- Infant-directed singing is a medium for parents and infants to communicate in a mutual relationship. Parental infant-directed singing is a multisensory, biopsychosocial communication that applies to ill and vulnerable hospitalised infants. The primary musical features of infant-directed singing are ideal for emotional coordination and sharing between parent and infant without the risk of over-stimulation. In this article, we suggest that parental infant-directed singing is regarded as a nonpharmacological emotion regulation intervention, which may modify the painful experience for both the infant and the parent before, during and after painful procedures in the neonatal intensive care context. Parents have the biopsychosocial resources to alleviate their infant’s pain through infant-directed singing, if they are empowered to do so and coached in this process. A music therapist specialised in neonatal music therapy methods can mentor parents in how to use entrained and attuned live lullaby singing in connection to painful procedures. Pain and the vast amount of painful procedures early in infancy, combined with early parent–infant separation and lack of parental participation in the care of the infant during neonatal intensive care, place arduous strain on the new family’s attachment process and on the infant’s and parents’ mental health, both from a short and long-term perspective. Therefore, we argue with biopsychosocial rationales, that live parental infant-directed singing should be promoted in neonatal pain care worldwide. Consequently, parents should be welcomed round the clock and invited as prescribed pain management for their infant.
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| 23. |
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| 24. |
- Anand, K J S, et al.
(författare)
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Effects of morphine analgesia in ventilated preterm neonates : primary outcomes from the NEOPAIN randomised trial
- 2004
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Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 363:9422, s. 1673-82
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Opioid analgesia is commonly used during neonatal intensive care. We undertook the Neurologic Outcomes and Pre-emptive Analgesia in Neonates (NEOPAIN) trial to investigate whether pre-emptive morphine analgesia decreases the rate of a composite primary outcome of neonatal death, severe intraventricular haemorrhage (IVH), and periventricular leucomalacia (PVL) in preterm neonates.METHODS: Ventilated preterm neonates (n=898) from 16 centres were randomly assigned masked placebo (n=449) or morphine (n=449) infusions. After a loading dose (100 microg/kg), morphine infusions (23-26 weeks of gestation 10 microg kg(-1) h(-1); 27-29 weeks 20 microg kg(-1) h(-1); 30-32 weeks 30 microg kg(-1) h(-1)) were continued as long as clinically justified (maximum 14 days). Open-label morphine could be given on clinical judgment (placebo group 242/443 [54.6%], morphine group 202/446 [45.3%]). Analyses were by intention to treat.FINDINGS: Baseline variables were similar in the randomised groups. The placebo and morphine groups had similar rates of the composite outcome (105/408 [26%] vs 115/419 [27%]), neonatal death (47/449 [11%] vs 58/449 [13%]), severe IVH (46/429 [11%] vs 55/411 [13%]), and PVL (34/367 [9%] vs 27/367 [7%]). For neonates who were not given open-label morphine, rates of the composite outcome (53/225 [24%] vs 27/179 [15%], p=0.0338) and severe IVH (19/219 [9%] vs 6/189 [3%], p=0.0209) were higher in the morphine group than the placebo group. Placebo-group neonates receiving open-label morphine had worse rates of the composite outcome than those not receiving open-label morphine (78/228 [34%] vs 27/179 [15%], p<0.0001). Morphine-group neonates receiving open-label morphine were more likely to develop severe IVH (36/190 [19%] vs 19/219 [9%], p=0.0024).INTERPRETATION: Pre-emptive morphine infusions did not reduce the frequency of severe IVH, PVL, or death in ventilated preterm neonates, but intermittent boluses of open-label morphine were associated with an increased rate of the composite outcome. The morphine doses used in this study decrease clinical signs of pain but can cause significant adverse effects in ventilated preterm neonates.
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