The effectiveness of non-pharmacological sleep interventions for improving inpatient sleep in hospital: A systematic review and meta-analysis.

BACKGROUND: Sleep disturbance is common in hospital. The hospital environment can have a negative impact on sleep quality, through factors such as noise, light, temperature, and nursing care disruptions. Poor sleep can lead to delays in recovery, wound healing, and increase risk of post-operative infection. METHODS: We conducted a systematic review evaluating the effectiveness of non-pharmacological sleep interventions for improving inpatient sleep. The primary outcome was sleep quality, the secondary outcome was length of hospital stay, the harm outcome was adverse events. MEDLINE, Embase, CINAHL, PsycINFO and the Cochrane Library were searched from inception to 17th February 2022. Meta-analysis was conducted using a fixed effects model, with narrative synthesis for studies with no useable data. Risk of bias was assessed with the Cochrane tool. RESULTS: 76 studies identified with 5375 people randomised comparing 85 interventions. Interventions focused on physical sleep aids (n = 26), relaxation (n = 25), manual therapy (n = 12), music (n = 9), psychological therapy (n = 5), light therapy (n = 3), sleep protocols (n = 2), milk and honey (n = 1), exercise (n = 1), and nursing care (n = 1). In meta-analysis, medium to large improvements in sleep quality were noted for sleep aids, relaxation, music, and manual therapies. Results were generally consistent in studies at lower risk of bias. Length of hospital stay and adverse events were reported for some studies, with benefit in some trials but this was not consistent across all interventions. CONCLUSIONS: Physical sleep aids, relaxation, manual therapy and music interventions have a strong evidence base for improving inpatient sleep quality. Research is needed to evaluate how to optimise interventions into routine care.

Optimising recruitment into trials using an internal pilot.

BACKGROUND: Recruitment to trials can be difficult. Despite careful planning and research that outlines ways to improve recruitment, many trials do not achieve their target on time and require extensions of funding or time. METHODS: We describe a trial in which an internal pilot with embedded qualitative research was used to improve recruitment processes and inform recruitment projections for the main trial. At the end of the pilot, it was clear that the sample size would not be met on time. Three steps were taken to optimise recruitment: (1) adjustments were made to the recruitment process using information from the qualitative work done in the pilot and advice from a patient and public involvement group, (2) additional recruiting sites were included based on site feasibility assessments and (3) a projection equation was used to estimate recruitment at each site and overall trial recruitment. RESULTS: Qualitative work during the pilot phase allowed us to develop strategies to optimise recruitment during the main trial, which were incorporated into patient information packs, the standard operating procedures and training sessions with recruiters. From our experience of feasibility assessments, we developed a checklist of recommended considerations for feasibility assessments. For recruitment projections, we developed a four-stage projection equation that estimates the number of participants recruited using a conversion rate of the number randomised divided by the number screened. CONCLUSIONS: This work provides recommendations for feasibility assessments and an easy-to-use projection tool, which can be applied to other trials to help ensure they reach the required sample size. TRIAL REGISTRATION: ISRCTN, ISRCTN92545361 . Registered on 6 September 2016.

Association of type 2 diabetes mellitus and seroprevalence for cytomegalovirus.

BACKGROUND: Infection is known to play a role in type 1 diabetes, but there is a paucity of information on its role in diabetes mellitus type 2. We examined the seroprevalence of selected viruses in a group of predominantly Hispanic patients with type 2 diabetes and control subjects without diabetes. METHODS: One hundred thirteen patients, 83 with type 2 diabetes and 30 control subjects, all undergoing hemodialysis at the same facility in San Antonio, Texas, were tested for antibodies against coxsackie B viruses, cytomegalovirus (CMV), and parvovirus. Sixty-six of these patients and 25 control subjects were tested bimonthly for 6 months. RESULTS: We observed a greater seroprevalence of anti-CMV IgG antibodies among patients with diabetes (97.6%), compared with control subjects (86.7%), and the difference was statistically significant [OR = 6.2, 95% CI: 1.1 to 36.0, P < 0.05]. Three draws on a subset of 91 patients produced still greater odds [OR = 12.4, 95% CI: 1.3 to 117, P < 0.05]. There were significantly more (P < or = 0.001) vascular complications among patients with diabetes. There was a colinearity of trends between diabetes, seropositivity to CMV, and age. CONCLUSIONS: Our findings indicated an up to 12 times greater odds of having type 2 diabetes for persons previously exposed to CMV. Since accelerated atherosclerosis is also associated with diabetes and CMV, past CMV infection may be a common factor that links atherosclerosis and diabetes. No other viruses tested in this study, either coxsackie B viruses or parvovirus, showed a significant association with type 2 diabetes.

[Laser tonsillectomy in tonsillar hyperplasia of early childhood]. / Die Lasertonsillotomie bei der Tonsillenhyperplasie des Kleinkindes.

Tonsillotomy, the partial resection of hyperplastic tonsils, is generally rejected in Germany as a treatment option for obstructions of the isthmus faucium in early childhood. We think this approach merits consideration. The favorable results obtained with tonsillotomy in the University Hospital Benjamin Franklin (n = 637), a private clinic, and an ENT practice with surgical facilities (n = 189) showed that there is no justification for adhering to literature reports of severe late complications with scarred tonsillar crypts and peritonsillar abscesses. No patient has developed any of these complications thus far. Following tonsillotomy, preoperative complaints (snoring, respiratory obstruction, dysphagia, and failure to grow) decreased considerably. Thus, tonsillotomy proved to be a suitable modality for treating tonsillar hyperplasia in early childhood. The prerequisite for long-term success is strict limitation of this intervention to the diagnosis of tonsillar hyperplasia.

[Course and form variations of cyclothymic phases in lithium therapy]. / Verlaufs- und Gestaltabwandlungen zyklothymer Phasen unter Lithiumtherapie.

The authors have attempted by means of a statistical survey to quantify changes in the course and, in particular the phase-related and non-phase-related form of cyclothymic phases during long-term lithium treatment.

[Patients, families and reform psychiatrists. A study on the relation between relatives of psychiatric patients and personnel of the psychiatric service in the province Arezzo/Italy]. / Patienten, Familien und Reformpsychiater. Eine Untersuchung zur Beziehung zwischen Angehörigen von Psychiatriepatienten und Mitarbeitern des Psychiatrischen Dienstes der Provinz Arezzo/Italien.

Discussions with relatives of patients whose patterns of signs and symptoms, case histories and fate can be considered as quite typical of the area to be looked after by psychiatric teams in Italian rural districts, show that the strictly outpatient psychiatric care approach practised by Italian psychiatrists according to the new regulations can work successfully wherever psychiatric teamworkers do more than just their duty. As a matter of fact, the so-called "reform law 180" is very vaguely worded when describing the tasks, responsibilities and competences of the medical and administrative personnel. The interviews of the author with the person concerned also showed clearly that psychiatric reform "alla italiana" need not result in chaos, although such chaos reigns supreme in Italy almost everywhere where psychiatric reform had been imposed by decree "from above" without any genuine readiness on the part of employees and coworkers of the institutions and without an appropriate cognitive and emotional process of learning which would have been absolutely necessary before translating the new approach into reality. We must say, however, that the chaotic conditions encountered here and there are not representative of Italian psychiatry as a whole; at the same time, the conditions seen by the author in the Casentino district are also definitely not representative of the conditions in Italy in general.(ABSTRACT TRUNCATED AT 250 WORDS)