Night‐time care routine interaction and sleep disruption in adult cardiac surgery

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/143693/1/jocn14262.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143693/2/jocn14262_am.pd

Sleep Apnea in a Sample of Patients with Treatment Resistant Depression Referred for Electroconvulsive Therapy

Objective Symptoms of sleep apnea (SA) often overlap with symptoms of depression. Without extensive exploration of a patient’s history it is possible that SA could complicate depression leading to treatment resistant depression (TRD) which is then referred for electroconvulsive therapy (ECT). To date no study has reported on prevalence of SA within this population. Materials and Methods We conducted a retrospective chart review of patients referred for ECT for TRD from 2008 to 2011 (N=118) at the Central Arkansas Veteran’s Healthcare System. Patients were placed into categories of known SA (diagnosed with polysomnography and recorded on chart), high risk SA (suspected SA documented in the chart by a physician), or unknown/low risk SA (negative polysmonography). Results Average age was 54.5±12 years. Average body mass index (BMI) was 30.3±7.3 kg/m2. 36% had either known SA (27%) or were at high risk of having SA (9%). Those with known SA were more likely to have hypertension (9.4 CI 3-29.5), BMI≥30 kg/m2 (5.4 CI 2.2-13.5), and hyperlipidemia (4.2 CI 1.6-11.4). Known SA was not significantly associated with diabetes mellitus (2.2 CI 0.8-5.6), complaints of pain (2.4 CI 0.9-5.9), or headache (1.5 CI 0.6-3.8). Conclusion A diagnosis of SA should be considered in patients referred for ECT for TRD. BMI≥30 kg/m2, presence of hypertension, and hyperlipidemia are more likely in patients with SA and should raise suspicion of the disorder in patients within this population

PACE - The first placebo controlled trial of paracetamol for acute low back pain: design of a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Clinical practice guidelines recommend that the initial treatment of acute low back pain (LBP) should consist of advice to stay active and regular simple analgesics such as paracetamol 4 g daily. Despite this recommendation in all international LBP guidelines there are no placebo controlled trials assessing the efficacy of paracetamol for LBP at any dose or dose regimen. This study aims to determine whether 4 g of paracetamol daily (in divided doses) results in a more rapid recovery from acute LBP than placebo. A secondary aim is to determine if ingesting paracetamol in a time-contingent manner is more effective than paracetamol taken when required (PRN) for recovery from acute LBP.</p> <p>Methods/Design</p> <p>The study is a randomised double dummy placebo controlled trial. 1650 care seeking people with significant acute LBP will be recruited. All participants will receive advice to stay active and will be randomised to 1 of 3 treatment groups: time-contingent paracetamol dose regimen (plus placebo PRN paracetamol), PRN paracetamol (plus placebo time-contingent paracetamol) or a double placebo study arm. The primary outcome will be time (days) to recovery from pain recorded in a daily pain diary. Other outcomes will be pain intensity, disability, function, global perceived effect and sleep quality, captured at baseline and at weeks 1, 2, 4 and 12 by an assessor blind to treatment allocation. An economic analysis will be conducted to determine the cost-effectiveness of treatment from the health sector and societal perspectives.</p> <p>Discussion</p> <p>The successful completion of the trial will provide the first high quality evidence on the effectiveness of the use of paracetamol, a guideline endorsed treatment for acute LBP.</p> <p>Trail registration</p> <p>ACTRN12609000966291.</p

Reverse logistics, stakeholders' influence, organizational slack, and managers' posture

Reverse logistics (RL) has strategic importance. However, little is known concerning what motivates firms to adopt RL systems. Drawing on stakeholder theory formulations, organizational slack, and the manager's strategic stance concept, this article develops a model that proposes external, internal, and individual factors that affect the implementation of RL programs. Our framework considers three major explicative variables: the attributes of the stakeholder (power, legitimacy and urgency), organizational slack for RL programs, and the manager's strategic posture. The study draws on a sample of 118 Spanish companies and uses a probit model to determine the influence of these factors on the probability of firms to implement RL systems. The study finds that customers, employees, and the government salience in terms of RL activities and manager's progressive posture have a significant influence on the final decision of implanting RL programs. Conversely, the study finds that shareholder salience negatively impacts the decision.Fundación BBVA and the project “Estrategias en las empresas europeas internacionales y medioambiente: análisis de recursos humanos, producción y negocio” for supporting this research. They also acknowledge the help of Prof. Dr. Carlos Larrinaga in providing access to financial statements. They are indebted as well to the Spanish Minister of Education and Science and the Comunidad Autónoma de Madrid which have provided financial support under the research projects entitled “Diseño e implantación de las estrategias medioambientales de aprovisionamiento, fabricación y comercialización: relación con el rendimiento organizativo” (sec2001-1578-c02- 01), “La dirección de operaciones y las teorías de stakeholders y de recursos y capacidades. Implicaciones estratégicas en la gestión del ciclo de vida de los equipos informáticos” (SEJ04- 07877-C02-02),. “Efectos de los distintos tipos de relaciones entre las empresas y sus mercados: prácticas de marketing, orientación al mercado y resultados económicos”, and “ Innovación versus imitacón: un test de la capacidad innovadora de las empresas de la Comunidad de Madrid “.Publicad

Objective and subjective assessment of sleep in chronic low back pain patients compared with healthy age and gender matched controls: a pilot study

<p>Abstract</p> <p>Background</p> <p>While approximately 70% of chronic low back pain (CLBP) sufferers complain of sleep disturbance, current literature is based on self report measures which can be prone to bias and no objective data of sleep quality, based exclusively on CLBP are available. In accordance with the recommendations of The American Sleep Academy, when measuring sleep, both subjective and objective assessments should be considered as the two are only modestly correlated, suggesting that each modality assesses different aspects of an individual's sleep experience. Therefore, the purpose of this study was to expand previous research into sleep disturbance in CLBP by comparing objective and subjective sleep quality in participants with CLBP and healthy age and gender matched controls, to identify correlates of poor sleep and to test logistics and gather information prior to a larger study.</p> <p>Methods</p> <p>15 CLBP participants (mean age = 43.8 years (SD = 11.5), 53% female) and 15 healthy controls (mean age = 41.5 years (SD = 10.6), 53% female) consented. All participants completed the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Pittsburgh Sleep Diary and the SF36v2. CLBP participants also completed the Oswestry Disability Index. Sleep patterns were assessed over three consecutive nights using actigraphy. Total sleep time (TST), sleep efficiency (SE), sleep latency onset (SL) and number of awakenings after sleep onset (WASO) were derived. Statistical analysis was conducted using unrelated t-tests and Pearson's product moment correlation co-efficients.</p> <p>Results</p> <p>CLBP participants demonstrated significantly poorer overall sleep both objectively and subjectively. They demonstrated lower actigraphic SE (p = .002) and increased WASO (p = .027) but no significant differences were found in TST (p = .43) or SL (p = .97). Subjectively, they reported increased insomnia (p =< .001), lower SE (p =< .001) and increased SL (p =< .001) but no difference between TST (p = .827) and WASO (p = .055). Statistically significant associations were found between low back pain (p = .021, r = -.589), physical health (p = .003, r = -.713), disability levels (p = .025, r = .576), and subjective sleep quality in the CLBP participants but not with actigraphy.</p> <p>Conclusion</p> <p>CLBP participants demonstrated poorer overall sleep, increased insomnia symptoms and less efficient sleep. Further investigation using a larger sample size and a longer period of sleep monitoring is ongoing.</p