Scholars agree that the many of therapeutic possibilities of music melody are due to its influence in the living process of the human being. It was born from their mind and emotions what gives it the power to attain changes in them (Arruda, 2005). This phenomenon happens due to the liberation of chemical cerebral substances that regulates humor, reduces aggressively and depression (Giannotti and Pizzoli, 2004). This chemical reaction is a valuable finding for the healthcare of patients in hospital environment, especially in IntensiveCare Units (ICU), where normally patients develop stress and anxiety sensations due to the high complexity environment (Backes, 2003) and surrounded with imaginary ideas of life ending thoughts when they have to deal with difficult and unknown situations (Leão et al., 2010; Souza and Marcheti, 2006). In this environment the music is able to influence and transform the context, the behavior and the feelings of the individuals (Backes, 2003).
ful intervention of post-stroke depression may improve clinical outcome and should be considered as a key to bet- ter stroke care. In this regard, our research is a leading study on the effects of musictherapy on mood, which may result in functional improvement by giving emotional support for stroke patients hospitalized in a rehabilitation unit. In the questionnaire for patients and caregivers, many subjects an- swered that they were satisfied with musictherapy and that it helped their rehabilitation. We found that further quantita- tive research into the effects of musictherapy on rehabilita- tion treatment is necessary.
43 Perceived psychosomatic effects for as well active and receptive musictherapy were relaxation and rest as well as increased power and vitality. Perceived psychological effects, which were congruent within all interventions, were mood improvement, release of positive emotions, distraction from stress and negative cancer-related emotions and increased self- awareness. Several of the perceived effects found in this study are in line with findings of studies with acute and palliative cancer patients, such as mood improvement (Weber et al., 1996; Hanser et al., 2006; Cassileth et al., 2003; Waldon, 2001; Gallagher et al., 2006) and relaxation (Bailey, 1983; Reinhardt, 1999, Cunningham et al., 1997; Hanser et al., 2006). Other findings, such as a decrease in anxiety could not be affirmed by our study. New findings in our study, compared to studies with palliative and acute patients, were increased self-confidence and self-esteem, a revelation of behaviour patterns and a stimulation to explore new behaviour within active musictherapy. These distinct findings might indicate that patients‟ needs depend on the stage of the treatment. Cancer patients in the post-hospital curative stage may deal with other issues and have other problems and needs than patients in acute or palliative situations. For example, reducing anxiety may play a more essential role during medical treatment and in the final stage of the disease. Acute patients are afraid of medical side-effects, such as pain, fatigue and nausea. Musictherapy can help to reduce fear and pain in order to endure the medical treatment and to counteract non-compliance. Knowing that one will die from cancer, decreasing fear of death and accepting the end of life could be aims of musictherapy within palliative care. Cancer
VAS were used to measure participants’ subjective feeling of pain, well-being and relaxation before and after the intervention. Graphical and statistical analysis showed no relevant mean differences between pre- and post-values in any of the three outcomes. The largest improvement occurred for well-being with a mean dif- ference of MD = 0.69 (±2.41). This contradicts findings from our previous study using a monochord interven- tion at bedside, where we found mean changes from pre to post of up to two points on a VAS with a larger sam- ple size of N = 84 . However, it would be false to conclude that the singing chair intervention does not affect these three dimensions, in general. Examination of the individual values revealed rather favorable baseline scores for pain (M = 1.65, SD = 2.21), relaxation (M = 7.90, SD = 1.64), and well-being (M = 7.05, SD = 1.77), giving a possible explanation for the lack of observable improvements. While the majority of terminally-ill pa- tients in palliative care suffer considerably from symp- toms such as pain, stress, and anxiety , the relatively strict inclusion criteria in the present study obviously led
pain and reduce perception of pain. Besides the benefits of music and playing music, the nature of the music has also been shown to be important in enhancing how emotionally engaging it is for patients. . (2006) found that, patient-preferred music listening greatly increased patients’ tolerance to pain and enhanced perceived control over pain. Music can reduce pain in several process such as: serve as a distracter, giving the patient a sense of control, causing the body to release endorphin to counteract pain, relaxes a person by slowing their ng and heart beat. Present study findings are in line with by Powers (2002) researches, which showed that music cause analgesia, especially when the patients preferred song or music used in therapy. Although the ic effect of music is not investigated . (2011); Hauck et al. (2013) suggested that music influence cognitively and emotionally on patients and effect on their pain perception. According to Frank (1985); Ezzone (1998) and Bozcuk (2006); music is useful to lessen treatment side effects such as pain in oncology patients. Music has culturally and scientifically been recognized as an effective motivator of emotions and a modulator of mood Lutz, Schmidt and Jäncke, 2006; Juslin and 2009; Bernatzky et al., 2011), and on the other hand, changed in emotions and mood can be effective in pain reduction (Tommaso et al., 2008; Villemure not yet clear about the specific hanisms of musictherapy which help to reduce pain,
. Therefore, it is postulated that both the early decision for or against antibiotic therapy as well as a continuous re-evalua- tion of the neccessity of anti-microbial therapy have a favorable influence on this development. Singh and colleagues  investigated intensivecarepatients with pneumonia and found that discontinuing antibiotic treatment after three days in the absence of a suspected infection did not worsen outcome. This approach could reduce the development of resistance. During the course of disease and treatment PCT-guided algo- rithms can help to shorten the length of antibiotic therapy with- out any unfavorable effects on treatment success and outcome. This is well-documented in the literature and by our own results [8,9].
Long-term musictherapy is also being investigat- ed in psychiatric patients. It has been known that music significantly increases alpha and reduc- es beta activity over time in patients with major depression, schizophrenia, or anxiety symptoms. Musictherapy also causes anxiety levels to drop. Authors give two explanations for these changes: pleasant music either helps patients enter a state of tranquillity or distracts them from unpleasant feelings by stimulating the auditory receptors. This may be done by mitigating the sympathetic nervous system and reducing its activity (23). In another study, which investigated musictherapy in patients diagnosed with depression, long-term musictherapy revealed a significant increase in the left frontotemporal alpha power, as well as in the left frontocentral and the right temporo- parietal theta power. Together with these chang- es, the reduction in Depression Scale – Anxiety Subscale scores was observed, indicating reduced anxiety after musictherapy. According to au- thors, these patterns reveal action and treatment effects of musictherapy on cortical activity in de- pression, as well as a possible neural reorganiza- tion (24).
The main objective of the present study was to conduct an in depth study of the advances made in the therapy with music and the developments made in its applications in the health care, using primarily resources of published material in the internet. The current study was mainly aimed at understanding musictherapy from the perspective of its applications in the field of medicine as a novel alternative therapy. Musictherapy is defined as a holistic and utilitarian approach towards treatment by applying music or specialized sounds with a view to cure disease or disease conditions in a completely non invasive manner. Apart from the advantage that it does not have any side effects, it also have an added advantage that it is a completely patient friendly therapy, that is the therapy can be conducted in the comfort zone of the patient. It is the psychological and emotional approach towards treatment that makes this therapy stands out from the conventional therapies. The main objective of musictherapy is to alter the patient’s psychological condition and increase their receptivity towards the medication. Recent researchers are pointing out the effectiveness of this therapy in the treatment of Alzheimer’s, Parkinson’s and dementia and a lot of positive research conclusions are accumulating, promising the future of musictherapy as a potential therapy.
Depression is also approaching as a clinical feature of patients admitted in critical units. It is significantly more common than symptoms of PTSD and is characterized by weakness, appetite changes and intense fatigue—all signs of somatic or physical depression are seen in two-thirds of the patients, as opposed to cognitive symptoms such as sadness, guilt or pessimism (Robert Hatch, 2018). There are various diagnostic tools to identify the presence of anxiety and depression. Some of them which are generally applied on ICU patients are enlisted in the Table no. 1 (Tools for anxiety assessment). It is very much necessary to manage ICU anxiety and depression to overcome critical psychological outcomes. The pharmacological treatment available for managing and rehabilitating the health status is mainly classified in four classes of medications such as selective serotonin reuptake inhibitor (SSRI), serotonin- norepinephrine reuptake inhibitor (SNRI), tricyclic antidepressant, and benzodiazepine. The dosage and duration of treatment is altered on the basis of age, gender, symptoms and adverse effects (Linda, 2017). On the other hand, innumerable complementary therapies and alternative medicines are available to subside these problems. Some of them include- herbal interventions, nutritional supplements, massage, and aromatherapy. Cognitive interventions like Mindfulness-based stress reduction (MBSR) can be used which combines of mindfulness meditation, body awareness, and explores patient’s behaviour, thinking, feelings, and actions (Gill van der Watt, 2008). Regular interviews can also be planned to lighten their anxiety and it prevents depression too. The development of a calm and therapeutic environment may also help.
therapy, and the difference between them was found statistically significant (p<.001). A research, useds a pre-test, post-test and control groups. They investigated the effects of music on the oxygen saturation levels of the patients who had clamp operations after percutaneous coronary intervention, andshowed that the average oxygen saturation levels of the patients in the test group were statistically higher than those of the control group (5). In a study divided artificial respiration patients into two groups to investigate the effects of music on their oxygen saturation levels, and found that the oxygen saturation averages of the test group were considerably higher than that of the control group. This increase was considered statistically significant (28). The results of the study conform with those of the research. Musictherapy can be used to raise SPO 2 .
study. Due to the small population of volunteer ICU nurses, it was difficult to find a sufficient sample size of subjects with suitable characteristics for randomization. In general, the major problem with quasi-experimental designs is that the experimental and control group might not be similar in terms of the demographic parameters selected for intervention and comparison. This lack of recruitment numbers required the control group to be from an asymptomatic population. However, the experi- mental and control group in our study were homoge- neous for age, height, weight and BMI (Table 1). Our study was limited to investigating the effects of a home- exercise therapy programme on CROM and LROM. Other intervention strategies (e.g. participatory ergo- nomics) that could increase the effectiveness of any programme should also be taken into consideration . As the aetiology of cervical and lumbar disorders is multi- factorial, a combination of intervention programmes for intensivecare nurses should be studied in the future . However, as the cost-effectiveness of any intervention method is an important consideration, it would be ideal to find effective and low-cost interventions .
Another factor that might influence the lower de-escalation rate in our study was the high proportion of unidentified organisms (culture-negative) from culture and sensitivity results. This might limits the opportunity for de-escalation. In the light of literature and guidelines, antibiotic de-escalation in culture-negative patients is not being adequately addressed. The decision about when and how to de-escalate is left to clinical judgment. In some circumstances, the culture-negative result does not correlate with the patient’s severe condition and this contributed to the prolonged use of empirical antibiotics. Managing culture-negative result in septic patients is one of the known challenges of antibiotic de-escalation. 3,13
This review article will discuss the recommended and peer-approved use of procalcitonin in septic patients in the intensivecare unit (ICU) and its use as a guide to antibiotic initiation and termination. Due to the volu- minous research on procalcitonin and in order to draw appropriate conclusions from the data, this review article will focus only on the use of procalcitonin in septic patients in an ICU setting. Since the procalcito- nin level is much higher in septic patients than those with an isolated pulmonary infection, results from these over- lapping studies (pulmonary infection without sepsis, pul- monary infection with sepsis, and non-pulmonary sepsis) will be addressed and compared to substantiate the cutoff levels of procalcitonin and its appropriate use as a bio- marker of sepsis. The article will focus on the prospective randomized trials (Level 1 evidence) that have been con- ducted, and lesser levels of evidence will be referenced as needed to substantiate a conclusion.
ity and dependency independently predicted mortality, and the need for hospitalization and institutionalization. As both comorbidity and dependency increase with age, more elderly people are living longer in more tenuous states of health. The proportion of elderly patients admitted to the hospital and intensivecare is considerable compared with the general population, and data from the McDermid and Bagshaw study suggest an increasing trend in elderly admissions. A previously published study has shown that elderly patients often receive less intensivetherapy and face greater support limitations when admitted to intensivecare, implying that there may be a selection bias among elderly patients triaged for access to finite critical care. 1 This may be due to the consumption of
In our PICU, children are managed by resident postgraduate doctors, skilled nursing staff and supervised by senior consultants round the clock. Often these patients arrived late with multiple complications leading to mortality despite the best available therapy. Poverty, illiteracy, lack of proper transportation facilities and lack of resources further adds to the challenge of managing sick children in developing countries. Pearson et al have suggested that the availability of full time trained pediatric intensivist can deliver high quality care with much higher efficiency than general pediatrician . People working in PICU in developing countries face many problems like lack of resources, knowledge and the support system. Still, lives of many children can be saved by judicious use of available facilities like oxygen, fluids, antibiotics and careful goal-oriented monitoring of patients. A trained paediatric intensivist may help by working closely with general paediatricians, training residents and nurses in advanced procedures, developing and updating unit protocols taking into consideration the existing human, logistic and financial resources. The intensivist may also be helpful for training peripheral units on stabilization and transportation of sick children. These facts highlight the necessity to strengthen the existing health care system and develop facilities for proper transportation and treatment of critically ill children.
If we ask if there is an organizing structure behind this chain of scenes or events, we ask about an underlying “script”. According to Monsen, the term “script” refers to “underlying principles for the organization of scenes, for instance a set of rules the individual has acquired for prediction, interpretation, handling of forms of reactions and control of repeating experiences” (Monsen, 1997, p. 98). A script is an underlying structure, a way to organize and make order out of experience, which is independent of the specific situation and context and emerges in different scenes. As we can see, music listening offers possibilities of activating scripts. In therapy, understanding this dynamic may be an important part in self-understanding, self- development and change. In self psychology it is important to have patients come into contact with model scenes in their lives, in order to experience how they feel and react. This identification may often come through as a cognitive process, resulting in an intellectual understanding. However, as we understand, emotions play a crucial role both in the identification and transformation of scripts. “Heating the script” may offer the possibility of recognizing the dynamics behind our idiosyncratic ways of reacting. Burning the maladaptive scripts may offer the possibility of replacing these with scripts better suited to cope with current problems. But this will need both an ability to identify and tolerate emotion as well as an opportunity to express the emotion verbally. This may be taken care of by introducing clients to different programs and under careful guidance follow the client through a broad landscape of scenes and emotions. I will postulate that music affords a way to intensify this process, something most BMGIM therapists have experienced quite often.
Treatment of chronic diseases in children is a special medical problem. Maintaining constant access to the central vascular system is necessary for long-term hemato-oncological and nephrological therapies as well as parenteral nutrition. Providing such access enables chemotherapic treatment, complete parenteral nutrition, long-term anti- biotic therapy, hemodialysis, treatment of intensivecare unit patients, monitoring blood pressure in the pulmonary artery and stimulation of heart rate in emergency situations as well as treatment of patients suffering from com- plications, especially when chances of access into peripheral veins are exhausted. Continuous access to the central vascular system is desirable in the treatment of chronically ill children. Insertion of a central venous catheter line eliminates the unnecessary pain and stress to a child patient accompanying injection into peripheral vessels. In order to gain long-term and secure access to the central venous system, respecting the guidelines of the Center for Disease Control and Prevention contained in the updated ‘Guidelines for the Prevention of Intravascular Catheter- Related Infections’ is necessary (Adv Clin Exp Med 2014, 23, 6, 1001–1009).
Volume overload due to salt and water retention fre- quently complicates AKI, occurring in 30 to 70% of ICU patients, and is associated with a greater risk of both morbidity and mortality [46-52]. Indeed, patients who remain responsive to diuretic treatment demonstrate outcome beneﬁ ts, as do patients exposed to restrictive ﬂ uid management in acute lung injury [53,54]. Although diuretics are still frequently employed in order to prevent oliguria [55,56], their use has not been translated into any perceived beneﬁ t in AKI . But even if the kidney is still (slightly) responsive to furosemide, ultraﬁ ltration by RRT removes ﬂ uid in an iso-isomolal way, that is, without inducing hypernatraemia and alkalosis. Consequently, in the presence of refractory severe volume overload, initia- tion of RRT appears indicated. Moreover, in the intensivecare setting, initiation of RRT is more fre quently triggered by oliguria expected to result in volume over- load rather than increases in conventional markers such as creatinine or urea [58,59].
Abstract: Managing psychological problems in patients admitted to intensivecare unit (ICU) is a big challenge, requiring pharmacological interventions. On the other hand, these patients are more prone to side effects and drug interactions associated with psychotropic drugs use. Benzodiazepines (BZDs), antidepressants, and antipsychotics are commonly used in critically ill patients. Therefore, their therapeutic effects and adverse events are discussed in this study. Different studies have shown that non-BZD drugs are preferred to BZDs for agitation and pain management, but antipsychotic agents are not recommended. Also, it is better not to start anti- depressants until the patient has fully recovered. However, further investigations are required for the use of psychotropic drugs in ICUs.