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The purpose of this study was to examine what it is to be a mother and a band director from the perspectives of 15 women. The researcher hoped to create a document which will be helpful to band directors who are or who someday may become mothers. According to statements made in the Band Director Group on Facebook, there is a need for a sense of community among those who are mothers and band directors. The fundamental question that drove this study was "What is the experience of being both a mother and a band director?" Within that question, the joys and challenges of being both a mother and a band director were identified along with resources that mother/band directors reported as helpful. Also included is advice these women would share with others about managing this life. This research is a qualitative, phenomenological study of the experiences of women who are both mothers and band directors, using a social constructivist interpretive framework. Data collection included surveys, text messages and email messages. The most common topic of discussion was balance: balance of time, balance of financial resources, balance of household duties, balance of childcare, and balance of emotional self. The first category, "Logistical Concerns," addressed such things as arranging childcare and caring for the home. The second category, "Time Management," addressed the time mother/band directors spend with and without their children. The third category is "Resources and Support." This category has the subtopics of "Supportive Husband," "Friends and Family," and "Discrimination." The fourth category, "Emotional Effects," has additional subtopics: "Advice Shared," "Beneficial Effects of Music on Children," and "Beneficial Effects of the Band Family on Children." It was found that much like other working mothers, mothers who direct bands must become excellent managers of their resources. Coordinating childcare for evening and weekend obligations is an idea which surfaced many times throughout the data collection and literature review phases of this study. Supportive husbands can have a powerful influence in this area, providing care for their children, assisting their wives with logistical details of running rehearsals and setting up for concerts, and sporting a positive attitude regarding job demands. Family and in-laws can also have a significant, positive impact on the function of the mother/band director's family by their involvement and support. [Paper presented at the Annual Meeting of the Texas Music Educators Association (San Antonio, TX, Feb 2014).]

In this systematic review, we compared the effectiveness of telehealth with in-person care during the pandemic using PubMed, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from March 2020 to April 2023. We included English-language, U.S.-healthcare relevant studies comparing telehealth with in-person care conducted after the onset of the pandemic. Two reviewers independently screened search results, serially extracted data, and independently assessed the risk of bias and strength of evidence. We identified 77 studies, the majority of which (47, 61%) were judged to have a serious or high risk of bias. Differences, if any, in healthcare utilization and clinical outcomes between in-person and telehealth care were generally small and/or not clinically meaningful and varied across the type of outcome and clinical area. For process outcomes, there was a mostly lower rate of missed visits and changes in therapy/medication and higher rates of therapy/medication adherence among patients receiving an initial telehealth visit compared with those receiving in-person care. However, the rates of up-to-date labs/paraclinical assessment were also lower among patients receiving an initial telehealth visit compared with those receiving in-person care. Most studies lacked a standardized approach to assessing outcomes. While we refrain from making an overall conclusion about the performance of telehealth versus in-person visits the use of telehealth is comparable to in-person care across a variety of outcomes and clinical areas. As we transition through the COVID-19 era, models for integrating telehealth with traditional care become increasingly important, and ongoing evaluations of telehealth will be particularly valuable. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is the fastest-growing neurological disease in the world. A key challenge in PD is tracking disease severity, progression, and medication response. Existing methods are semisubjective and require visiting the clinic. In this work, we demonstrate an effective approach for assessing PD severity, progression, and medication response at home, in an objective manner. We used a radio device located in the background of the home. The device detected and analyzed the radio waves that bounce off people's bodies and inferred their movements and gait speed. We continuously monitored 50 participants, with and without PD, in their homes for up to 1 year. We collected over 200,000 gait speed measurements. Cross-sectional analysis of the data shows that at-home gait speed strongly correlates with gold-standard PD assessments, as evaluated by the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III subscore and total score. At-home gait speed also provides a more sensitive marker for tracking disease progression over time than the widely used MDS-UPDRS. Further, the monitored gait speed was able to capture symptom fluctuations in response to medications and their impact on patients' daily functioning. Our study shows the feasibility of continuous, objective, sensitive, and passive assessment of PD at home and hence has the potential of improving clinical care and drug clinical trials. Smart gait tracker: Tracking progression of Parkinson's disease (PD) requires long visits to the clinic and is subjected to several biases. To facilitate objective evaluation of disease state in individuals with PD, Liu et al. developed a home device able to detect and analyze movements of individuals while performing day-to-day activities. The device emits radio waves and detects them after they bounce back off the people's body, inferring gait speed. Testing in 50 participants showed that the device performed better than the gold standard in tracking disease progression over time and was able to detect positive response to treatment, suggesting that at-home continuous monitoring could improve disease management in individuals with PD. [ABSTRACT FROM AUTHOR]

Background: Open‐source automated insulin delivery (AID) is a user‐driven treatment modality used by thousands globally. Healthcare professionals' (HCPs) ability to support users of this technology is limited by a lack of knowledge of these systems. Aims: To describe the challenges experienced by HCPs supporting participants' use of open‐source automated insulin delivery in the Community deRivEd AuTomatEd insulin delivery (CREATE) study. Methods: Data were collected prospectively from the study team's fortnightly meetings and Slack Workspace (Slack Technologies, Ltd. 2018) during the first 4 months of the trial. Key topics were identified from minutes of meetings. Slack conversations were categorised by topic, with the number of posts per conversation, number of sites per conversation and involvement of experts in open‐source AID being recorded. Results: In the first 4 months of the trial, there were 254 conversations in Slack with a mean of 5.2 (±4.25) posts per conversation. The most frequent learning challenge was insulin pump and cannula problems relating to the DANA‐iTM insulin pump, which totalled 24.0% of all conversations. Experts on open‐source AID use were involved in 83.3% of conversations. Conclusions: A significant proportion of challenges related to specific devices, rather than AID. Challenges relating to the functioning of open‐source AID were more likely to involve input from experts in open‐source AID. This is the first report of challenges experienced by a multidisciplinary team in a supported open‐source environment that may inform expectations in routine clinical care. [ABSTRACT FROM AUTHOR]

Appropriate models of survivorship care for the growing number of adult survivors of childhood cancer are unclear. We conducted a realist review to describe how models of care that include primary care and relevant resources (eg, tools, training) could be effective for adult survivors of childhood cancer. We first developed an initial program theory based on qualitative literature (studies, commentaries, opinion pieces) and stakeholder consultations. We then reviewed quantitative evidence and consulted stakeholders to refine the program theory and develop and refine context-mechanism-outcome hypotheses regarding how models of care that include primary care could be effective for adult survivors of childhood cancer. Effectiveness for both resources and models is defined by survivors living longer and feeling better through high-value care. Intermediate measures of effectiveness evaluate the extent to which survivors and providers understand the survivor's history, risks, symptoms and problems, health-care needs, and available resources. Thus, the models of care and resources are intended to provide information to survivors and/or primary care providers to enable them to obtain/deliver appropriate care. The variables from our program theory found most consistently in the literature include oncology vs primary care specialty, survivor and provider knowledge, provider comfort treating childhood cancer survivors, communication and coordination between and among providers and survivors, and delivery/receipt of prevention and surveillance of late effects. In turn, these variables were prominent in our context-mechanism-outcome hypotheses. The findings from this realist review can inform future research to improve childhood cancer survivorship care and outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To perform a mixed methods review to evaluate the effectiveness and implementation of models for integrating palliative care into ambulatory care for US adults with noncancer serious chronic illness.Methods: We searched 3 electronic databases from January 2000 to May 2020 and included qualitative, mixed methods studies and randomized and nonrandomized controlled trials. For each study, 2 reviewers abstracted data and independently assessed for quality. We conducted meta-analyses as appropriate and graded strength of evidence (SOE) for quantitative outcomes.Results: Quantitative analysis included 14 studies of 2,934 patients. Compared to usual care, models evaluated were not more effective for improving patient health-related quality of life (HRQOL) (standardized mean difference [SMD] of 4 of 8 studies, 0.19; 95% CI, ‒0.03 to 0.41) (SOE: moderate) or for patient depressive symptom scores (SMD of 3 of 9 studies, ‒0.09; 95% CI, ‒0.35 to 0.16) (SOE: moderate). Models might have little to no effect on patient satisfaction (SOE: low) but were more effective for increasing advance directive (AD) documentation (relative risk, 1.62; 95% CI, 1.35 to 1.94) (SOE: moderate). Qualitative analysis included 5 studies of 146 patients. Patient preferences for appropriate timing of palliative care varied; costs, additional visits, and travel were considered barriers to implementation.Conclusion: Models might have little to no effect on decreasing overall symptom burden and were not more effective than usual care for improving HRQOL or depressive symptom scores but were more effective for increasing AD documentation. Additional research should focus on identifying and addressing characteristics and implementation factors critical to integrating models to improve ambulatory, patient-centered outcomes. [ABSTRACT FROM AUTHOR]