Pre-hospital transdermal glyceryl trinitrate in patients with stroke mimics: data from the RIGHT-2 randomised-controlled ambulance trial

Background Prehospital stroke trials will inevitably recruit patients with non-stroke conditions, so called stroke mimics. We undertook a pre-specified analysis to determine outcomes in patients with mimics in the second Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial (RIGHT-2). Methods RIGHT-2 was a prospective, multicentre, paramedic-delivered, ambulance-based, sham-controlled, participant-and outcome-blinded, randomised-controlled trial of transdermal glyceryl trinitrate (GTN) in adults with ultra-acute presumed stroke in the UK. Final diagnosis (intracerebral haemorrhage, ischaemic stroke, transient ischaemic attack, mimic) was determined by the hospital investigator. This pre-specified subgroup analysis assessed the safety and efficacy of transdermal GTN (5 mg daily for 4 days) versus sham patch among stroke mimic patients. The primary outcome was the 7-level modified Rankin Scale (mRS) at 90 days. Results Among 1149 participants in RIGHT-2, 297 (26%) had a final diagnosis of mimic (GTN 134, sham 163). The mimic group were younger, mean age 67 (SD: 18) vs 75 (SD: 13) years, had a longer interval from symptom onset to randomisation, median 75 [95% CI: 47,126] vs 70 [95% CI:45,108] minutes, less atrial fibrillation and a lower systolic blood pressure and Face-Arm-Speech-Time tool score than the stroke group. The three most common mimic diagnoses were seizure (17%), migraine or primary headache disorder (17%) and functional disorders (14%). At 90 days, the GTN group had a better mRS score as compared to the sham group (adjusted common odds ratio 0.54; 95% confidence intervals 0.34, 0.85; p = 0.008), a difference that persisted at 365 days. There was no difference in the proportion of patients who died in hospital, were discharged to a residential care facility, or suffered a serious adverse event. Conclusions One-quarter of patients suspected by paramedics to have an ultra-acute stroke were subsequently diagnosed with a non-stroke condition. GTN was associated with unexplained improved functional outcome observed at 90 days and one year, a finding that may represent an undetected baseline imbalance, chance, or real efficacy. GTN was not associated with harm. Trial registration This trial is registered with International Standard Randomised Controlled Trials Number ISRCTN 26986053.

Are community music therapy principles relevant to my work with large groups of older adults in a residential care facility?

<p>This research focuses on my student practicum placement at a residential care home offering rest home, hospital and specialist dementia care for older people. A significant part of my work at the home was facilitating large, open groups, as ensuring the maximum number of residents could participate in music therapy each week was a priority for the facility. Due to my background in community music, which included work in care homes, I was interested in whether community music therapy principles would have relevance in this context. I wanted to improve my practice and add value to my work and in doing so I also hoped to contribute to the wider conversation around the distinction between community music and community music therapy, and how these two disciplines can enhance and support each other. Using an interpretivist framework I engaged in action research, an orientation towards the research process which focuses on real-world change. I conducted three action cycles, collecting data for each cycle over a period of approximately six weeks. I then used thematic analysis to examine this data. My main data source was my practice notes, which included reflections and ideas for improvement. I also drew on the community music therapy literature to develop my practice. Based on emerging themes, I generated actions I could take in the next cycle to advance and improve my practice. I found that large group music therapy sessions can provide the opportunity for participants, both staff and residents, to experience a shared social space which enables moments of connection and promotes inclusion, creativity, self-determination, and expanded identities. This suggests that the groups had therapeutic value for the participants. I discuss identified differences between my community music and music therapy practice, including the possibilities for individual work and use of music therapy theory. I believe that community music therapy principles were relevant to this work and in particular taking an ecological perspective was significant. Further research into community music therapy in residential care settings is recommended.</p>

Are community music therapy principles relevant to my work with large groups of older adults in a residential care facility?

<p>This research focuses on my student practicum placement at a residential care home offering rest home, hospital and specialist dementia care for older people. A significant part of my work at the home was facilitating large, open groups, as ensuring the maximum number of residents could participate in music therapy each week was a priority for the facility. Due to my background in community music, which included work in care homes, I was interested in whether community music therapy principles would have relevance in this context. I wanted to improve my practice and add value to my work and in doing so I also hoped to contribute to the wider conversation around the distinction between community music and community music therapy, and how these two disciplines can enhance and support each other. Using an interpretivist framework I engaged in action research, an orientation towards the research process which focuses on real-world change. I conducted three action cycles, collecting data for each cycle over a period of approximately six weeks. I then used thematic analysis to examine this data. My main data source was my practice notes, which included reflections and ideas for improvement. I also drew on the community music therapy literature to develop my practice. Based on emerging themes, I generated actions I could take in the next cycle to advance and improve my practice. I found that large group music therapy sessions can provide the opportunity for participants, both staff and residents, to experience a shared social space which enables moments of connection and promotes inclusion, creativity, self-determination, and expanded identities. This suggests that the groups had therapeutic value for the participants. I discuss identified differences between my community music and music therapy practice, including the possibilities for individual work and use of music therapy theory. I believe that community music therapy principles were relevant to this work and in particular taking an ecological perspective was significant. Further research into community music therapy in residential care settings is recommended.</p>

Experience of internationally qualified nurses providing palliative care in a New Zealand aged residential care facility

Background: New Zealand is reliant upon internationally qualified nurses (IQNs) working within aged residential care (ARC), despite the fact that many of these nurses have limited or no ARC or palliative care experience before arriving in the country. Aims: To understand the issues faced by IQNs providing palliative care to people in ARC. To understand how the palliative aged residential care (PARC) specialist nurse team can best support IQNs. Methods: A thematic analysis was undertaken from five focus group interviews with IQNs (n=24) from ARC facilities in the Christchurch and Canterbury regions. Findings: Unfamiliarity with New Zealand 's palliative care and ARC systems, cultural differences and communication barriers caused internal struggles. Transitioning to a New Zealand approach to palliative care highlighted participants' adaptability and resilience. Consistent approaches to training and support by the PARC team and additional cultural training within New Zealand Competence Assessment Programmes (CAP) are required. Conclusion: Ongoing education, support and role modelling to develop confidence and reduce internal struggles are required for IQNs providing palliative care in ARC.

Transitions to Long-Term Residential Care Settings

During their life course, many older adults encounter a transition between care settings, for example, a permanent move into long-term residential care. This care transition is a complex and often fragmented process, which is associated with an increased risk of negative health outcomes, rehospitalisation, and even mortality. Therefore, care transitions should be avoided where possible and the process for necessary transitions should be optimised to ensure continuity of care. Transitional care is therefore a key research topic. The TRANS-SENIOR European Joint Doctorate (EJD) network builds capacity for tackling a major challenge facing European long-term care systems: the need to improve care for an increasing number of care-dependent older adults by avoiding unnecessary transitions and optimising necessary care transitions. During this symposium, four presenters from the Netherlands and Switzerland will present different aspects of transitions into long-term residential care. The first speaker presents the results of a co-creation approach in developing an intervention aimed at preventing unnecessary care transitions. The second speaker presents an overview of interventions aiming to improve a transition from home to a nursing home, highlighting the clear mismatch between theory and practice. The third speaker presents the impact of the COVID-19 pandemic on transitions into long-term residential care using an ethnographic study in a long-term residential care facility in Switzerland. The final speaker discusses the results of a recent Delphi study on key factors influencing implementing innovations in transitional care. The discussant will relate previous findings on transitional care with a U.S. perspective.

Aging and Masculinity in Bibliotherapy and Poetry Groups for Men in Late Life

The transition to residential care facility may symbolize the joining into the 'community of older people'. This may influence the ways men in late life construct their identities and the intersection of aging and masculinity. Due to some barriers, this experience may be difficult to express explicitly. Bibliotherapy aims to bridge this gap by using literature to address diverse issues in the form of reading and writing activities. In this presentation we will present "The Literary Parliament" project, in which bibliotherapy and poetry groups of men in late life were conducted in residential care facilities in Israel. We will present findings of a qualitative research which explored poems written by group participants, and the way these helped participants to express their perceptions and feelings of ageing and masculinity in the context of residential care. The use of bibliotherapy to encourage psychological discourse among men in late life will be discussed.

Adults with neuro-disabling conditions: Exploring the ways music therapy can support residents in a long term care facility

<p>This exegesis presents findings which emerged from secondary review of clinical practice data collected during a music therapy placement. The setting for this research is a long-term residential care facility for people with a variety of physical and neurological conditions, including cerebral palsy, traumatic brain injury, stroke and multiple sclerosis, aged 18 to 65. The aim of the facility is to maximise the quality of life for people with physical disabilities and those with terminal illnesses. The research aim was to develop theory about how music therapy can provide support to people with long term neurological conditions. Thematic analysis was employed to develop core themes about the support that music therapy has provided. These findings are presented under the following six themes: building relationships, collaborative practices, fostering community, acknowledging diversity, emotional support and musical engagement. These themes all focus on relatedness, and the quality of life of individuals, groups and the community. They also indicate the value of a flexible community-centred approach for delivering music therapy. A vignette from clinical practice is included to illustrate important points made in the exegesis. The study complements other music therapy research situated within a health-care perspective and could offer particular significance for new music therapy practitioners looking to understand and work with people with neuro-disabilities in long term care facilities.</p>

Adults with neuro-disabling conditions: Exploring the ways music therapy can support residents in a long term care facility

<p>This exegesis presents findings which emerged from secondary review of clinical practice data collected during a music therapy placement. The setting for this research is a long-term residential care facility for people with a variety of physical and neurological conditions, including cerebral palsy, traumatic brain injury, stroke and multiple sclerosis, aged 18 to 65. The aim of the facility is to maximise the quality of life for people with physical disabilities and those with terminal illnesses. The research aim was to develop theory about how music therapy can provide support to people with long term neurological conditions. Thematic analysis was employed to develop core themes about the support that music therapy has provided. These findings are presented under the following six themes: building relationships, collaborative practices, fostering community, acknowledging diversity, emotional support and musical engagement. These themes all focus on relatedness, and the quality of life of individuals, groups and the community. They also indicate the value of a flexible community-centred approach for delivering music therapy. A vignette from clinical practice is included to illustrate important points made in the exegesis. The study complements other music therapy research situated within a health-care perspective and could offer particular significance for new music therapy practitioners looking to understand and work with people with neuro-disabilities in long term care facilities.</p>

Involving Family Members of People with Dementia in the Music Therapy Process at a Residential Care Facility

<p>The therapeutic use of music with older adults with dementia is widely documented, and family involvement is encouraged in both music therapy practice and dementia care services. This qualitative study explores and describes the experience of a student music therapist involving the family members of people with dementia in the music therapy process in a residential care facility. Grounded theory methodology informed analysis of the data sources. Secondary data was analysed and a theoretical perspective regarding family involvement in the music therapy process in this setting was developed. The findings are presented in main categories consisting of: building relationships, sharing information, unplanned family involvement in music therapy sessions, flexibility, spontaneity, joy and humour, and negotiation of the music therapist role in the community of the facility. The emergent theoretical perspective suggests that involving family members in the music therapy process in residential care facility is valuable in fostering and strengthening a sense of community between residents, family members and care staff.</p>

Involving Family Members of People with Dementia in the Music Therapy Process at a Residential Care Facility

<p>The therapeutic use of music with older adults with dementia is widely documented, and family involvement is encouraged in both music therapy practice and dementia care services. This qualitative study explores and describes the experience of a student music therapist involving the family members of people with dementia in the music therapy process in a residential care facility. Grounded theory methodology informed analysis of the data sources. Secondary data was analysed and a theoretical perspective regarding family involvement in the music therapy process in this setting was developed. The findings are presented in main categories consisting of: building relationships, sharing information, unplanned family involvement in music therapy sessions, flexibility, spontaneity, joy and humour, and negotiation of the music therapist role in the community of the facility. The emergent theoretical perspective suggests that involving family members in the music therapy process in residential care facility is valuable in fostering and strengthening a sense of community between residents, family members and care staff.</p>