David Stott

Therapeutic songwriting in music therapy Part I: : Who are the therapists, who are the clients, and why is songwriting used?

Songwriting as a therapeutic intervention has received increasing attention in the field of music therapy over the past decade however much of the publications focus on clinical outcomes rather than methods of practice. This paper, part of a two-part research report into trends in the clinical practice of songwriting, aims to describe the most frequently employed goal areas across a range of clinical populations and compare these findings with the published literature. Responses to a 21-question online survey were obtained from 477 professional music therapists practicing in 29 countries which focused on approaches to songwriting within their practice with a single clinical population. Chi–square or comparable Exact tests (Fisher-Freeman-Halton) were applied to the data and significant associations were found according to different clinical populations particularly with respect to the aims of songwriting in clinical practice and the frequency with which songwriting is employed in practice. The data highlights that songwriting is frequently employed in developmental disability and ASD practice, with reports on songwriting with these diagnostic groups being underrepresented in the music therapy literature. The survey identified that the most frequently endorsed goal areas align with the literature base and included a) experiencing mastery, develop self-confidence, enhance self esteem; b) choice and decision making; c) develop a sense of self; d) externalising thoughts, fantasies, and emotions; e) telling the clients story; and f) gaining insight or clarifying thoughts and feelings.

Therapeutic songwriting in music therapy, Part II: Comparing the literature with practice across diverse clinical populations

A growing body of literature on therapeutic songwriting with diverse clinical populations indicates that clinicians employ a wide range of approaches. The purpose of this research was to establish trends in the clinical practice of songwriting as implemented across a range of clinical populations. Responses to a 21-question online survey were obtained from 419 professional music therapists practicing in 29 countries which focused on approaches to songwriting within their practice with a single clinical population. Results suggest that, in general, the literature provides good representation for what is occurring in clinical practice. Generally, songs were composed with individual clients in single sessions, with lyrics created prior to the music. Clinicians had a significant role in creating the music with improvised and pre-determined musical structures being equally employed. Chi-square or comparable Exact tests (Fisher–Freeman–Halton) were applied to the data and significant associations were found according to clinical populations, particularly with respect the number of sessions required to complete a song, approaches to composing lyrics and music, the context with which songwriting was employed, and the types of allied health professionals involved in the songwriting interventions. There is a distinct absence of songwriting literature as applied in developmental disability, autism spectrum disorder, and aged care contexts so the resulting practice trends offered here contribute to the increasing body of knowledge about songwriting practices.

Potential novel application of dual time point SUV measurements as a predictor of survival in head and neck cancer.

ObjectivesTo examine the potential of pre-treatment dual time point [18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) as a tool for improving the assessment of head and neck cancer. Two main areas were investigated: (a) optimum time to start FDG scanning post-injection and (b) potential of SUV obtained from dual time point scanning as a prognostic indicator of survival. MethodsTwelve patients with advanced head and neck cancer were prospectively studied. Each patient was scanned using a Siemens Ecat Exact-47 PET scanner at 1 h and 2 h post-injection. Maximum tumour uptake (SUVt) and ratio of maximum tumour/normal tissue uptake (SUVt/n) were recorded. The optimal time to initiate scanning was investigated by comparing SUVt and SUVt/n with the decision made by two experienced observers as to which scan they preferred to report from, given the choice of the 1 h and 2 h scan in each patient. ResultsA significant difference between 1 h and 2 h SUVt (P<0.004, paired t-test) and between 1 h and 2 h SUVt/n (P<0.0003, paired t-test) was observed. All 2 h SUVt and SUVt/n were greater in magnitude than their respective 1 h SUVt and SUVt/n counterparts. The two observers reported an identical number of lesions from the 1 h and 2 h scans but preferred the 2 h data. ConclusionsTumour stage and the percentage difference in 1 h and 2 h SUVt showed potential as prognostic indicators of long-term survival.

The estimation of body height from ulna length in healthy adults from different ethnic groups

BACKGROUND   Assessments of nutritional status frequently incorporate a measure of height to evaluate a persons relative thinness or fatness. Because height is often difficult to quantify, it may be predicted from alternative anthropometric measurements, including ulna length. Little information is available about the accuracy of these predictions in an ethnically diverse population. The present study aimed to evaluate published equations for predicting height from ulna length in adults from different ethnic groups. METHODS   Ulna length and standing height were measured in a gender-stratified sample of 60 Asian, 69 Black and 65 White healthy volunteers, aged 21-65 years. Height was predicted from ulna length using the Malnutrition Universal Screening Tool (MUST) equations and compared against the measured values. Linear regression analysis was used to develop equations to estimate height from ulna length and to explore the relationship between height and ulna length in subgroups. RESULTS   The mean (SD) age for Asian, Black and White in men was 31.7 (11.0), 32.0 (10.3) and 38.6 (12.5) years and in women was 26.2 (5.4), 32.6 (8.9) and 35.7 (11.7); the mean (SD) height in men was 170.9 (5.2), 178.1 (7.3) and 176.3 (7.7) cm and in women was 157.7 (4.7), 164.0 (5.9) and 163.7 (6.2) cm. Ulna length and measured height were significantly correlated among all subgroups, except Asian women (r=0.11, P=0.57). The mean (SD) difference between predicted and measured height showed significant overestimates for Asian and Black men [4.0 (4.8) and 6.7 (5.3) cm] and Asian and Black women [6.4 (4.9) and 4.4 (4.9) cm] but not for White men and women. CONCLUSIONS   The MUST equations for predicting height from ulna length in healthy adults should be used with some caution among ethnically diverse populations, particularly in Asian women.

Change in the moving bodymind: Quantitative results from a pilot study on the use of the BodyMind approach (BMA) to psychotherapeutic group work with patients with medically unexplained symptoms (MUSs)

Abstract Background: This article reports quantitative results from a pilot study in primary care (PC) undertaken from 2004–2007. The intervention programme, derived from movement psychotherapy, was termed ‘Learning groups: the BodyMind approach (BMA),’ and emphasised a verbal and non-verbal integrated model, awareness of the inter-relationship between body and mind and a self-managing framework. Aim: To evaluate systematically the outcomes of a 12-week group BMA intervention programme with patients suffering from anxiety/depression with at least one chronic (over two years) medically unexplained symptom (MUS), another term for a psychosomatic condition or somatoform disorder. Method: A mixed method was applied to a single-case design. Outcome measures completed at baseline, mid-, post- intervention and three-month follow-up were the Measure Yourself Medical Outcome Profile (MYMOP) and the Counselling Outcome Routine Evaluation (CORE). Results: Increased activity levels and well-being; more effective copi...

A morphometric study of the human ear

AIMS We examined variations in the shape of the human ear according to age, sex and ethnic group with particular attention to ear prominence. METHODS 420 volunteers were recruited. Measurements included; head height and length, ear height and axis, antihelix taken off angle, earlobe length and width, ear width at the helical root and tragus. Prominence was measured at the helical root and tragus (conchomastoid angle, conchal bowl depth and helical-mastoid distance). RESULTS Good symmetry was shown for all measurements. Ethnically Indian volunteers had the largest ears (both length and width), followed by Caucasians, and Afro-Caribbeans. This trend was significant in males (p<0.001), but not significant in females (p=0.087). Ears increased in size throughout life. Subjectively, only 2% of volunteers felt their ears were prominent compared to 10% in the opinion of the principal investigator. No objective measurements were identified that accurately predicted subjective perceptions of prominence. CONCLUSIONS We found consistent trends in ear morphology depending on ethnic group, age and sex. Our study was unable to define an objective method for assessing ear prominence. Decisions about what constitutes a prominent ear should be left to personal and aesthetic choice.

Assessment of clinical response after two cycles of primary chemotherapy in breast cancer

Background Complete clinical (cCR) and pathological (pCR) response to neoadjuvant chemotherapy in breast cancer is associated with improved survival. Various imaging and immunological techniques have been tested as predictors of response early in the course of chemotherapy, but their predictive value has not been compared with that of a simple early clinical assessment. Patients and methods Two hundred breast cancer patients (T2-4, N0-1) were treated with neoadjuvant chemotherapy. Clinical response after two cycles of treatment was compared with final clinical and pathological response. The likelihood of achieving cCR or pCR was compared by response after two cycles. Results Overall final clinical response rate was 79% (30.5% cCR and 11.9% pCR). After two cycles of chemotherapy, clinical response rate was 54.5%. For responders after two cycles, final cCR = 51.3% and pCR = 21.5%. For non-responders after two cycles, cCR = 5.5% and pCR = 1.2%. Response after two cycles predicts for pCR (P = 0.003; sensitivity 95.2%, specificity 52.9%). Conclusions Clinical response after two cycles of chemotherapy predicts for pCR and is a valid early endpoint that could be incorporated into the design of future neoadjuvant trials.

Can radiological assessment of abdominal computerized scans diagnose encapsulating peritoneal sclerosis in long term peritoneal dialysis patients

Encapsulating peritoneal sclerosis (EPS) is a rare but potentially devastating complication of long‐term peritoneal dialysis (PD). Changes to the peritoneal membrane occur with duration of PD therapy. To determine the potential effect of prospective computerized tomography (CT) scanning, we reviewed the scans of patients who had developed EPS compared with those without EPS.

Weight Loss as a Primary Objective of Therapeutic Groups for Obese Women: Two Preliminary Studies.

ABSTRACT The studies reported here explored whether therapeutic groups for women who eat compulsively can demonstrate weight loss as a primary result as well as the improvements in emotional functioning reported by other investigators. In both studies questionnaire data showed little change in self-esteem or attitudes as measured by the Rosenberg Self-Esteem and the Eating Disorders Examination. However, interview data showed considerable changes in attitudes and emotional functioning. The initial study demonstrated no weight loss but marked changes in participants’ attitudes to themselves and food, likely to lead to weight loss. A second, longer, uncontrolled study again showed changes in emotional functioning plus weight loss of 5% or more of initial body weight at the end of the intervention in 75% of participants who completed the study (n=8) or 50% of those who were initially recruited (n=12). Weight loss has been maintained in 75% of participants at 18-month follow-up. The data are based on a small sample, which can only be suggestive but supports a further study.