Mapping of OpenEHR Archetypes to FHIR Resources in Use Case Oncology

Unambiguous data exchange among healthcare systems is essential for error-free reporting and improved patient care. Mapping of different standards plays a crucial role in making different systems communicate with each other and have an efficient healthcare systems. This work focuses on exploring the possibilities of semantic interoperability between two widely used clinical modelling standards, OpenEHR and FHIR (Fast Healthcare Interoperability Resources). A manually curated map is being developed where the same semantically meaning OpenEHR Archetypes are mapped to the relevant FHIR Resources.

Reminiscence-Focused Music Therapy to Promote Positive Mood and Engagement and Shared Interaction for People Living With Dementia

Although there is a growing body of evidence suggesting that combining music therapy and reminiscence in a structured and complementary way may yield positive well-being outcomes for people with dementia, there is a gap in the literature combining both in equal measure. Furthermore, there are no known studies exploring the use of ‘associative items’ as part of the combined intervention and no known standardised protocol or method currently exists. This mixed methods study aims to explore whether combining music therapy and reminiscence with associative items for people with dementia may promote positive mood and engagement levels and shared interaction through (a) musical expression, (b) reminiscence and (c) verbal interaction. Five weekly reminiscence-focused music therapy (RFMT) sessions with associative items were conducted with a group of five people with dementia living in a residential care unit. Results from the Dementia Care Mapping (DCM) revealed that the RFMT intervention was highly effective in promoting positive mood and engagement levels and shared interaction. Participants exhibited considerable positive mood and engagement (+3) 51.6%, and high positive mood and engagement (+5) 38.2%, of the total time observed. The three most frequent behaviours across the five RFMT sessions included musical expression, which was observed 53.2% of the time, reminiscence, observed 23% of the time, and verbal interaction, observed 34% of the total time observed. Data from the music therapist’s reflective journal and session summaries revealed that the associative items prompted reality orientation, verbal interaction, and cognitive stimulation. The music elements were found to increase group cohesion, stimulate cognition, and act as an anchor, re-orientating group members intermittently. Implications of practice are considered, and future recommendations of practice are outlined.

Staff experiences of implementing Dementia Care Mapping to improve the quality of dementia care in care homes: a qualitative process evaluation

Background Dementia Care Mapping™ (DCM) is a widely used, staff-led, psychosocial intervention to support the implementation of person-centred care. Efficacy evaluations in care homes have produced mixed outcomes, with implementation problems identified. Understanding the experiences of staff trained to lead DCM implementation is crucial to understanding implementation challenges, yet this has rarely been formally explored. This study aimed to examine the experiences of care home staff trained to lead DCM implementation, within a large cluster randomised controlled trial. Methods Process evaluation including, semi-structured interviews with 27 trained mappers from 16 intervention allocated care homes. Data were analysed using template variant of thematic analysis. Results Three main themes were identified 1) Preparedness to lead - While mappers overwhelmingly enjoyed DCM training, many did not have the personal attributes required to lead practice change and felt DCM training did not adequately equip them to implement it in practice. For many their expectations of the mapper role at recruitment contrasted with the reality once they began to attempt implementation; 2) Transferring knowledge into practice – Due to the complex nature of DCM, developing mastery required regular practice of DCM skills, which was difficult to achieve within available time and resources. Gaining engagement of and transferring learning to the wider staff team was challenging, with benefits of DCM largely limited to the mappers themselves, rather than realised at a care home level; and 3) Sustaining DCM - This required a perception of DCM as beneficial, allocation of adequate resources and support for the process which was often not able to be provided, for the mapper role to fit with the staff member’s usual duties and for DCM to fit with the home’s ethos and future plans for care. Conclusions Many care homes may not have staff with the requisite skills to lead practice change using DCM, or the requisite staffing, resources or leadership support required for sustainable implementation. Adaptations to the DCM tool, process and training may be required to reduce its complexity and burden and increase chances of implementation success. Alternatively, models of implementation not reliant on care home staff may be required.

Evaluation of a Music Intervention on Well-being and Behavior of People with Dementia Using Dementia Care Mapping

Introduction: Dementia Care Mapping (DCM) was originally developed as an observation tool to examine person-centered care in long-term care facilities and to evaluate the quality of life and well-being of people with dementia (PwD). However, the effects of a music intervention using this tool have not been investigated so far. This leads to the following research question: How does a music intervention which involves music therapy and other music-based interventions affect the observed well-being and behavior of PwD living in nursing homes? Methods: In this 14-week, non-controlled music intervention study, data from 30 PwD aged between 52 and 97 (M = 81.4 years) were analyzed. DCM coding involves continuous observation for five hours on four days in the baseline and intervention phase. In the follow-up phase PwD were mapped on two days for five hours. The DCM method were used to measure well-being and certain behaviors of PwD. Results: The well-being during the observation remained almost constant and corresponds to a neutral state of affect and focused contact, with no indication of positive or negative sensations. Significant improvements in certain behaviors were observed in the course from baseline to intervention phase. For example, it was shown that physical activities of the participants, such as (instructed) sports exercises, strengthening or physically challenging exercises in the intervention phase were significantly higher (M = 0.99, SD = 1.82) than at baseline phase (M = 0.00, SD = 0.00) (z = -2.37, p = .02, n = 26). Similar results were shown for expressive/creative activities or work-related activities (e.g. washing dishes). Conclusion: In summary, it can be stated that music interventions can promote communication and movement. However, musical stimulation is not one of the essential components of improving behavioral and psychological symptoms or well-being for PwD in nursing homes.