What Are the Right Tools for Studying Arts in Health Interventions?

The arts can touch places that are difficult to recognize and understand, capture in words, or measure by numbers-whether you're an artist, a patient, or an educator. This ineffability presents a dilemma for practitioners and researchers in arts in health when questions of legitimacy, efficacy, program implementation, and research funding are tied to outcomes-based research. Ethical tensions arise when traditional public health and clinical research methods are the wrong tools for capturing what's vital about the arts. This article argues that being a responsible arts in health researcher requires interrogating what counts as evidence, especially when the insistence on rigor risks oversimplifying and diminishing the power of the arts. It further argues for equity in arts in health research, including equity in investigative strategies that value both the arts and the research.

Mindfulness-based interventions for medication adherence: A systematic review and narrative synthesis.

OBJECTIVE: Inadequate medication adherence is a significant limitation for achieving optimal health outcomes across chronic health conditions. Mindfulness-based interventions (MBIs) have been increasingly applied to promote medical regimen adherence as MBIs have been shown to improve patient-level barriers to adherence (i.e., depressive symptoms, cognitive impairment, stress). The purpose of this review is to investigate the state of research regarding MBIs targeting medication adherence in chronic illnesses and to identify evidence gaps to inform future studies. METHODS: The search reviewed 5 databases (e.g., PubMed, PsycINFO, Embase, CINAHL, Proquest Thesis/Dissertations) to identify trials that quantitatively evaluated the effect of MBIs on medication adherence. Study abstracts and full texts were screened identifying eligible studies, and findings were summarized using a narrative synthesis. RESULTS: A total of 497 studies were reviewed; 41 were eligible for full text review and 9 were included in narrative synthesis: seven were RCTs and two were pre-post designs. Study quality varied, with five rated moderate or high risk for bias. Clinical populations tested included living with HIV (k = 3), cardiovascular disease (k = 3), psychological disorders (k = 2), and men who underwent a radical prostatectomy (k = 1). Four studies found significant improvements in medication adherence, however only two of these studies had low risk of bias. CONCLUSIONS: Research on MBI's for medication adherence is developing, but the effectiveness of MBIs remains unclear due to the nascent stage of evidence and methodological limitations of existing studies. Researchers should prioritize rigorous experimental designs, theory-driven investigations of behavioral mechanisms, and the use of objective measurements of adherence.

Artists on the Research Team: An Interdisciplinary Approach to Team Science, Research Rigor, and Creative Dialogue.

In an arts in public health research team, artists may be undervalued as key research collaborators because of the difficulties in skillful integration of experts who possess not only different bodies of knowledge but also different ways of examining and valuing the world. Under the stewardship of two Rhode Island state agencies, an innovative research-driven enterprise, comprising researchers, clinicians, and community artists, was brought together to integrate arts-based interventions into statewide public health policy and practice. Here, we examine our work with the Rhode Island Arts and Health Advisory Group as a case study to illuminate our experiences in collaborating with artists on public health policy and practice research. Using existing frameworks from the literature, we define the attributes of, and challenges to, successful research collaborations and identify from our work how these apply to interdisciplinary collaborations between artists and public health practitioners. To support others working at the nexus of arts in public health, we include key experiences that were specific to the engagement of artists in research teams.

The Use of Music in the Treatment and Management of Serious Mental Illness: A Global Scoping Review of the Literature.

Mental and substance use disorders have been identified as the leading cause of global disability, and the global burden of mental illness is concentrated among those experiencing disability due to serious mental illness (SMI). Music has been studied as a support for SMIs for decades, with promising results; however, a lack of synthesized evidence has precluded increased uptake of and access to music-based approaches. The purpose of this scoping review was to identify the types and quantity of research at intersections of music and SMIs, document evidentiary gaps and opportunities, and generate recommendations for improving research and practice. Studies were included if they reported on music's utilization in treating or mitigating symptoms related to five SMIs: schizophrenia, bipolar disorder, generalized anxiety disorder, major depressive disorder, or post-traumatic stress disorder. Eight databases were searched; screening resulted in 349 included studies for data extraction. Schizophrenia was the most studied SMI, with bipolar disorder studied the least. Demographics, settings, and activity details were found to be inconsistently and insufficiently reported; however, listening to recorded music emerged as the most common musical activity, and activity details appeared to have been affected by the conditions under study. RCTs were the predominant study design, and 271 unique measures were utilized across 289 primary studies. Over two-thirds of primary studies (68.5%) reported positive results, with 2.8% reporting worse results than the comparator, and 12% producing indeterminate results. A key finding is that evidence synthesis is precluded by insufficient reporting, widely varied outcomes and measures, and intervention complexity; as a result, widespread changes are necessary to reduce heterogeneity (as feasible), increase replicability and transferability, and improve understandings of mechanisms and causal pathways. To that end, five detailed recommendations are offered to support the sharing and development of information across disciplines.

Heterogeneity of outcomes for intraoperative music interventions: a scoping review and evidence map.

BACKGROUND: Over the past 30 years, numerous studies have been performed that assess the efficacy of intraoperative music as an adjunctive means to regional and local anaesthesia to improve clinical outcomes. Despite an emerging body of evidence and growing adoption of music in surgical settings, the variety of interventions studied, and the heterogeneity of outcomes and outcome measurement tools applied makes difficult the task of aggregating evidence. OBJECTIVE: This study assesses the state of the field of intraoperative musical interventions by documenting and visualising the breadth of outcomes measured in studies. DESIGN: Scoping review and evidence map. METHODS: Three electronic databases (PubMed, Embase and a music-focussed research database, RILM (International Music Literature Repository)) were searched for full-text articles published between January 1991 and July 2019. Results from these searches were screened and relevant data was extracted from full-text articles on type of music intervention and type of anaesthesia; outcomes measured were recorded in an evidence map in order to identify the current state of the field and assess for trends in outcome measurements. INTERVENTIONS: Music administered to adult patients via headphones or speakers under regional or local sedation in during the intraoperative period. RESULTS: Twenty-one studies with a total of 2283 patients were included. A total of 42 unique outcomes were measured across the 21 studies, with each measuring an average of 6.41±2.63 outcomes. Systolic blood pressure, diastolic blood pressure, heart rate, anxiety, pain, patient satisfaction, respiratory rate and sedation requirements were the most prevalent outcomes reported. Only 15 outcome measures (36%) were used in more than one study, while the remaining 27 outcome measures (64%) were identified in only one study in our review. CONCLUSIONS: Our scoping review identifies that almost two-thirds of studies in this field used >1 outcome measure unique to that study (not also used in other studies), which hinders opportunities to aggregate data across studies and meta-analyse evidence. Future studies should provide clear documentation regarding the intervention and consider using valid and reliable outcome tools. Researchers should consider standardisation when appropriate and adopting the use of core outcome sets for conditions where these sets have been developed.

What Cy Twombly's Art Can Teach Us About Patients' Stories.

Some patients' stories can be hard to tell and hard to listen to, especially in pressured, time-pinched clinical environments. This difficulty, however, doesn't absolve clinicians from a duty to try to understand patients' stories, interpret their meanings, and respond with care. Such efforts require clinical creativity, full engagement, and the recognition that emotions and personal feelings leak into the space between storyteller and story listener. Art objects are complex bodies of information that can challenge clinicians and trainees to become more comfortable with messy narratives as well as with ethical and aesthetic ambiguity. By slowing down and observing art, trainees can reflect on how clinicians make sense of stories that contain information that appears random and lacks coherence-and, more importantly, how clinicians draw on these stories to respond to patients' needs.

Community-engaged Evidence Synthesis to Inform Public Health Policy and Clinical Practice: A Case Study.

BACKGROUND: This case study documents the work of the Rhode Island Arts and Health Advisory Group, which convened in 2016 to develop a set of policy, clinical practice, and research recommendations for implementation by the Rhode Island Department of Health, The Rhode Island State Council on the Arts, and partners. Comprised of artists, clinicians, community members, and patients, the group partnered with researchers to complete an evidence synthesis project of arts-based health care interventions. METHODS: The group took a community-engaged approach to evidence synthesis, featuring the use of online, and in-person training materials to facilitate the codesign and coexecution of the evidence synthesis protocol. The final evidence map was translated into an online evidence map to facilitate analysis and discussion on arts-based interventions in health care. RESULTS: The evidence map informed the development of recommendations for advancing the integration of arts and health in the state. The project evaluation indicated that our community-engaged approach to evidence synthesis promoted engagement as defined by the PCORI Engagement Strategy Rubric (ie, reciprocal relationships, partnership, colearning, transparency, honesty, and trust). Participation also improved community research partners confidence in engaging with the health care system, developed greater empathy and understanding of others in the community, and increased interest in using science or research in advocacy efforts. CONCLUSIONS: Engaging community partners in evidence synthesis promotes community dialogue and engagement in research, specifically towards: (1) elucidating outcomes of import to patients and communities that are not represented in the medical literature; and (2) identifying comparisons among interventions that resonate with patients and communities.

Opioids and pain in the emergency department: a narrative crisis.

The opioid crisis poses challenges to patients who come to the emergency department (ED) in pain and the clinicians who have a duty to offer relief. In search of help, patients often find suspicion. But clinicians have reasons to be concerned about feeding addiction and its lethal consequences. This article discusses the narrative challenges facing many clinicians in the ED tasked with caring for complex patients in pain. It will discuss the many ways our brains are influenced by story, and how this susceptibility is often beyond our grasp. And yet, narrative and story skills present great opportunities for improving pain management, not only when it comes to opioids, but by returning the focus back to the patient in pain.

Does information from ClinicalTrials.gov increase transparency and reduce bias? Results from a five-report case series.

BACKGROUND: We investigated whether information in ClinicalTrials.gov would impact the conclusions of five ongoing systematic reviews. METHOD: We considered five reviews that included 495 studies total. Each review team conducted a search of ClinicalTrials.gov up to the date of the review's last literature search, screened the records using the review's eligibility criteria, extracted information, and assessed risk of bias and applicability. Each team then evaluated the impact of the evidence found in ClinicalTrials.gov on the conclusions in the review. RESULTS: Across the five reviews, the number of studies that had both a registry record and a publication varied widely, from none in one review to 43% of all studies identified in another. Among the studies with both a record and publication, there was also wide variability in the match between published outcomes and those listed in ClinicalTrials.gov. Of the 173 total ClinicalTrials.gov records identified across the five projects, between 11 and 43% did not have an associated publication. In the 14% of records that contained results, the new data provided in the ClinicalTrials.gov records did not change the results or conclusions of the reviews. Finally, a large number of published studies were not registered in ClinicalTrials.gov, but many of these were published before ClinicalTrials.gov's inception date of 2000. CONCLUSION: Improved prospective registration of trials and consistent reporting of results in ClinicalTrials.gov would help make ClinicalTrials.gov records more useful in finding unpublished information and identifying potential biases. In addition, consistent indexing in databases, such as MEDLINE, would allow for better matching of records and publications, leading to increased utility of these searches for systematic review projects.

Agency for Healthcare Research and Quality Evidence-based Practice Center methods provide guidance on prioritization and selection of harms in systematic reviews.

OBJECTIVES: Systematic reviews should provide balanced assessments of benefits and harms, while focusing on the most important outcomes. Selection of harms to be reviewed can be a challenge due to the potential for large numbers of diverse harms. STUDY DESIGN AND SETTING: A workgroup of methodologists from Evidence-based Practice Centers (EPCs) developed consensus-based guidance on selection and prioritization of harms in systematic reviews. Recommendations were informed by a literature scan, review of Evidence-based Practice Center reports, and interviews with experts in conducting reviews or assessing harms and persons representing organizations that commission or use systematic reviews. RESULTS: Ten recommendations were developed on selection and prioritization of harms, including routinely focusing on serious as well as less serious but frequent or bothersome harms; routinely engaging stakeholders and using literature searches and other data sources to identify important harms; using a prioritization process (formal or less formal) to inform selection decisions; and describing the methods used to select and prioritize harms. CONCLUSION: We provide preliminary guidance for a more structured approach to selection and prioritization of harms in systematic reviews.

AHRQ series on complex intervention systematic reviews-paper 2: defining complexity, formulating scope, and questions.

BACKGROUND: The early stages of a systematic review set the scope and expectations. This can be particularly challenging for complex interventions given their multidimensional and dynamic nature. RATIONALE: This paper builds on concepts introduced in paper 1 of this series. It describes the methodological, practical, and philosophical challenges and potential approaches for formulating the questions and scope of systematic reviews of complex interventions. Furthermore, it discusses the use of theory to help organize reviews of complex interventions. DISCUSSION: Many interventions in medicine, public health, education, social services, behavioral health, and community programs are complex, and they may not fit neatly within the established paradigm for reviews of straightforward interventions. This paper provides conceptual and operational guidance for these early stages of scope formulation to assist authors of systematic reviews of complex interventions.

Mutagenic evidence for the optimal control of evolutionary dynamics.

Elucidating the fitness measures optimized during the evolution of complex biological systems is a major challenge in evolutionary theory. We present experimental evidence and an analytical framework demonstrating how biochemical networks exploit optimal control strategies in their evolutionary dynamics. Optimal control theory explains a striking pattern of extremization in the redox potentials of electron transport proteins, assuming only that their fitness measure is a control objective functional with bounded controls.