Bea Tiemens

Music‐assisted relaxation to improve sleep quality: meta‐analysis

AIM This paper is a report of a meta-analysis conducted to evaluate the efficacy of music-assisted relaxation for sleep quality in adults and elders with sleep complaints with or without a co-morbid medical condition. BACKGROUND Clinical studies have shown that music can influence treatment outcome in a positive and beneficial way. Music holds the promise of counteracting psychological presleep arousal and thus improving the preconditions for sleep. DATA SOURCES We conducted a search in the Embase (1997 - July 2008), Medline (1950 - July 2008), Cochrane (2000 - July 2008), Psychinfo (1987 - July 2008) and Cinahl (1982 - July 2008) databases for randomized controlled trials reported in English, German, French and Dutch. The outcome measure of interest was sleep quality. METHODS Data were extracted from the included studies using predefined data fields. The researchers independently assessed the quality of the trials using the Delphi list. Only studies with a score of 5 points or higher were included. A pooled analysis was performed based on a fixed effect model. RESULTS Five randomized controlled trials with six treatment conditions and a total of 170 participants in intervention groups and 138 controls met our inclusion criteria. Music-assisted relaxation had a moderate effect on the sleep quality of patients with sleep complaints (standardized mean difference, -0.74; 95% CI: -0.96, -0.46). Subgroup analysis revealed no statistically significant contribution of accompanying measures. CONCLUSION Music-assisted relaxation can be used without intensive investment in training and materials and is therefore cheap, easily available and can be used by nurses to promote music-assisted relaxation to improve sleep quality.

Effective components of feedback from Routine Outcome Monitoring (ROM) in youth mental health care: study protocol of a three-arm parallel-group randomized controlled trial.

BackgroundRoutine Outcome Monitoring refers to regular measurements of clients’ progress in clinical practice, aiming to evaluate and, if necessary, adapt treatment. Clients fill out questionnaires and clinicians receive feedback about the results. Studies concerning feedback in youth mental health care are rare. The effects of feedback, the importance of specific aspects of feedback, and the mechanisms underlying the effects of feedback are unknown. In the present study, several potentially effective components of feedback from Routine Outcome Monitoring in youth mental health care in the Netherlands are investigated.Methods/DesignWe will examine three different forms of feedback through a three-arm parallel-group randomized controlled trial. 432 children and adolescents (aged 4 to 17 years) and their parents, who have been referred to mental health care institution Pro Persona, will be randomly assigned to one of three feedback conditions (144 participants per condition). Randomization will be stratified by age of the child or adolescent and by department. All participants fill out questionnaires at the start of treatment, one and a half months after the start of treatment, every three months during treatment, and at the end of treatment. Participants in the second and third feedback conditions fill out an additional questionnaire. In condition 1, clinicians receive basic feedback regarding clients’ symptoms and quality of life. In condition 2, the feedback of condition 1 is extended with feedback regarding possible obstacles to a good outcome and with practical suggestions. In condition 3, the feedback of condition 2 is discussed with a colleague while following a standardized format for case consultation. The primary outcome measure is symptom severity and secondary outcome measures are quality of life, satisfaction with treatment, number of sessions, length of treatment, and rates of dropout. We will also examine the role of being not on track (not responding to treatment).DiscussionThis study contributes to the identification of effective components of feedback and a better understanding of how feedback functions in real-world clinical practice. If the different feedback components prove to be effective, this can help to support and improve the care for youth.Trial registrationDutch Trial Register NTR4234

Applicability of two brief evidence-based interventions to improve sleep quality in inpatient mental health care

The present study explored the applicability of two brief evidence-based interventions to improve sleep quality in inpatient psychiatry. The study involved three comparable admission wards of a psychiatric hospital. Stimulus control was introduced at the first ward, and music-assisted relaxation at the second. At the third ward, no intervention was introduced. A mixed-method study was employed. We found that nurses share the opinion that both interventions can be applied, but patients are hard to motivate. They perceived the lack of available time, busyness at the ward, and the lack of cooperation of patients as the main obstacles. The perception of a successful implementation is correlated with the perception of gained attention for sleep problems, the perception of increased care options, and the impression of effectiveness. Qualitative data showed that the effectiveness of the interventions was compromised by operational issues, commitment issues, adaptation to contextual limitations, and conflicting individual beliefs. We concluded that music-assisted relaxation is applicable in inpatient psychiatry. The application of stimulus control met with insurmountable operational issues. The nursing team is a very important factor for the implementation of evidence-based interventions at ward level. The lack of a shared urge for change and responsibility for continuity are important factors contributing to failure.

A prognostic index (PI) as a moderator of outcomes in the treatment of depression: A proof of concept combining multiple variables to inform risk-stratified stepped care models

BACKGROUND Prognostic indices (PIs) combining variables to predict future depression risk may help guide the selection of treatments that differ in intensity. We develop a PI and show its promise in guiding treatment decisions between treatment as usual (TAU), treatment starting with a low-intensity treatment (brief therapy (BT)), or treatment starting with a high-intensity treatment intervention (cognitive-behavioral therapy (CBT)). METHODS We utilized data from depressed patients (N=622) who participated in a randomized comparison of TAU, BT, and CBT in which no statistically significant differences in the primary outcomes emerged between the three treatments. We developed a PI by predicting depression risk at follow-up using a LASSO-style bootstrap variable selection procedure. We then examined between-treatment differences in outcome as a function of the PI. RESULTS Unemployment, depression severity, hostility, sleep problems, and lower positive emotionality at baseline predicted a lower likelihood of recovery across treatments. The PI incorporating these variables produced a fair classification accuracy (c=0.73). Among patients with a high PI (75% percent of the sample), recovery rates were high and did not differ between treatments (79-86%). Among the patients with the poorest prognosis, recovery rates were substantially higher in the CBT condition (60%) than in TAU (39%) or BT (44%). LIMITATIONS No information on additional treatment sought. Prospective tests needed. CONCLUSION Replicable PIs may aid treatment selection and help streamline stepped models of care. Differences between treatments for depression that differ in intensity may only emerge for patients with the poorest prognosis.

The MATCH cohort study in the Netherlands: rationale, objectives, methods and baseline characteristics of patients with (long-term) common mental disorders.

Research in the last decades shows that common mental disorders may be long‐term and severely disabling, resulting in severe mental illness (SMI). The percentage of Dutch SMI‐patients with common mental disorders receiving mental health services is estimated at 65–70%. However, it is unclear which patients in fact become SMI‐patients. We need to know more about the possible course of common mental disorders, understand the origins of chronicity in more detail, and have more insight in related care processes and care use of patients with common mental disorders.

EBP: beginnen bij de vraag of bij het antwoord?

SamenvattingOp 4 december 2007 bezocht ik als kersvers redactielid het congres Evidence Based Practice in de Verpleegkundige Praktijk. Ik kon me daar tussen bijna 500 verpleegkundigen heerlijk onderdompelen in de presentaties over wat EBP in de verpleegkundige praktijk inhoudt en over de wijze waarop beschikbare evidence geïmplementeerd kan worden. Ondanks alle presentaties, stuk voor stuk van hoge kwaliteit, bleef mijns inziens gedurende de dag één vraag onbeantwoord, namelijk: waar begin je?

Potential predictive factors for successful referral from specialist mental-health services to less intensive treatment: A concept mapping study

Referring patients from specialist mental-health services (provided by multiple healthcare service providers and aimed at relieving symptoms of mental illness) to less intensive care (provided by a nurse or psychologist in cooperation with a general practitioner and aimed at improving quality of life) is feasible from the perspective of patients, service providers, and mental-health services. However, it is unclear which patients are most suitable for referral to less intensive care. In this study, we used concept mapping to identify factors that might determine whether a referral from specialist mental services to less intensive care might be successful. Participants (N = 34) were recruited from different parts of the Netherlands and included general practitioners, peer workers, community mental-health nurses, and social workers from several services who were based in different neighborhoods. The participants generated 54 statements (31 after clean-up), which were sorted into five clusters and rated on their expected ability to predict successful referral. Ordered from highest to lowest on expected predictive value, the clusters of factors were: Patient characteristics, patients’ informal support system, patients’ social situation, organization of services, and service provider related factors. The ordering was the same for all of the service providers, except that general practitioners expected the organization of services to be the most predictive. The ordering of the clusters is mostly consistent with existing knowledge about recovery during mental healthcare. In order to further improve the number of successful referrals from specialist mental-health services to less intensive care, a prospective prediction study is needed.

A cost-effectiveness analysis to evaluate a system change in mental healthcare in the Netherlands for patients with depression or anxiety

Over the last decade, the Dutch mental healthcare system has been subject to profound policy reforms, in order to achieve affordable, accessible, and high quality care. One of the adjustments was to substitute part of the specialized care for general mental healthcare. Using a quasi-experimental design, we compared the cost-effectiveness of patients in the new setting with comparable patients from specialized mental healthcare in the old setting. Results showed that for this group of patients the average cost of treatment was significantly reduced by, on average, €2132 (p < 0.001), with similar health outcomes as in the old system.

Drijfveren de grote motor

Zowel van een professionele zorgorganisatie als van de zorgprofessional wordt verwacht dat de principes van evidence based practice (EBP) worden toegepast om kwalitatief hoogwaardige en doelmatige zorg te leveren. Evenzeer voor een organisatie als voor een zorgprofessional is dit een complexe verandering die vraagt om zowel visie, vaardigheden, drijfveren, middelen als een plan van aanpak[1]. In dit hoofdstuk wordt ingegaan op drijfveren. Als een organisatie of professionals niet inzien wat EBP oplevert of als het niet aansluit bij ambities, ontstaat logischerwijs weerstand. Om succesvolle veranderingen te bewerkstelligen is daarom aandacht voor drijfveren noodzakelijk.

Plan van aanpak geeft structuur

Vaak wordt in implementatiemodellen uitgegaan van een stapsgewijze lineaire aanpak, waarin fasen elkaar netjes opvolgen. Een implementatieproces verloopt echter zelden lineair en gaat dikwijls gepaard met tegenslagen en onverwachte wendingen. Ditzelfde geldt voor het implementatieproces van het evidence-based gedachtegoed in een instelling of een afdeling. Om hierop voorbereid te zijn moet een plan van aanpak niet alleen flexibel zijn, maar ook geschikt om de tegenslagen en problemen te signaleren, zodat daar snel op ingespeeld kan worden en een valse start wordt voorkomen.