Effects of Noise Reduction and Care Clustering on Quality of Sleep in Critical Care Patients

Introduction: Sleep deprivation has detrimental effects on critical patients’ health. A lack of sleep can affect multiple body systems. There are nursing interventions that can reduce sleep deprivation. However, there is inconclusive evidence on how to properly assess sleep deprivation and implement sleep promoting nursing interventions in clinical practice. Purpose: The purpose of this literature review is to examine the effects of noise reduction and nursing care clustering on improving the quality of patient sleep in the critical care setting. Methods: This literature review was conducted using 10 sources published within the last 5 years. Inclusion criteria consisted of articles about the effects of noise, quality of sleep, and implementation of nurse care clustering on various critical care populations. The 6 databases used for this research were UpToDate, CINAHL, PubMed, PsycInfo, Proquest, and CCForum. This research concentrated on examining articles containing nursing interventions for noise reduction and care clustering related to quality of sleep. Results: Noise has a negative effect on sleep by causing more arousals/awakenings, which greatly impacts the restorative function of the process. Noise is not the only sleep disturbing factor, but it has been shown to be significant. Some noise sources cannot be eliminated due to safety reasons, but interventions exist to help counteract the effects of noise. Nursing care interventions are as disruptive to sleep as noise. 13.9% of nursing interruptions could be safely omitted, and nurses should cluster care to promote sleep. Interventions to prevent sleep disruption can be practical in routine nursing, but nurses are less likely to implement them at night because prioritizing care clustering can require more time and effort. Discussion: Sleep deprivation causes major health concerns in critical care patients. Noise and nursing care interventions have been found to cause equal disruptions in sleep. Noise reduction and care clustering have been observed to reduce sleep deprivation. Further evidence is needed on how to effectively and practically implement these nursing interventions into daily nursing practice

Waiting time distribution in public health care: empirics and theory

Excessive waiting times for elective surgery have been a long-standing concern in many national healthcare systems in the OECD. How do the hospital admission patterns that generate waiting lists affect different patients? What are the hospitals characteristics that determine waiting times? By developing a model of healthcare provision and analysing empirically the entire waiting time distribution we attempt to shed some light on those issues. We first build a theoretical model that describes the optimal waiting time distribution for capacity constraint hospitals. Secondly, employing duration analysis, we obtain empirical representations of that distribution across hospitals in the UK from 1997–2005. We observe important differences on the ‘scale’ and on the ‘shape’ of admission rates. Scale refers to how quickly patients are treated and shape represents trade-offs across duration-treatment profiles. By fitting the theoretical to the empirical distributions we estimate the main structural parameters of the model and are able to closely identify the main drivers of these empirical differences. We find that the level of resources allocated to elective surgery (budget and physical capacity), which determines how constrained the hospital is, explains differences in scale. Changes in benefits and costs structures of healthcare provision, which relate, respectively, to the desire to prioritise patients by duration and the reduction in costs due to delayed treatment, determine the shape, affecting short and long duration patients differently

Child-computer interaction, ubiquitous technologies, and big data

In this forum we celebrate research that helps to successfully bring the benefits of computing technologies to children, older adults, people with disabilities, and other populations that are often ignored in the design of mass-marketed products. The children’s technology landscape is changing quickly. The ubiquity of interactive technologies means children can access them just about anytime, anywhere. At the same time, these technologies constantly collect data from and about children, bringing them into the age of big data, voluntarily or not. These developments have the potential to significantly change children’s relationship to technology and the long-term impact of technology use. To discuss these changes, the child-computer-interaction community held a special interest group (SIG) meeting during the CHI 2018 conference

Corridors of barchan dunes: stability and size selection

Barchans are crescentic dunes propagating on a solid ground. They form dune fields in the shape of elongated corridors in which the size and spacing between dunes are rather well selected. We show that even very realistic models for solitary dunes do not reproduce these corridors. Instead, two instabilities take place. First, barchans receive a sand flux at their back proportional to their width while the sand escapes only from their horns. Large dunes proportionally capture more than they loose sand, while the situation is reversed for small ones: therefore, solitary dunes cannot remain in a steady state. Second, the propagation speed of dunes decreases with the size of the dune: this leads -- through the collision process -- to a coarsening of barchan fields. We show that these phenomena are not specific to the model, but result from general and robust mechanisms. The length scales needed for these instabilities to develop are derived and discussed. They turn out to be much smaller than the dune field length. As a conclusion, there should exist further - yet unknown - mechanisms regulating and selecting the size of dunes.Comment: 13 pages, 13 figures. New version resubmitted to Phys. Rev. E. Pictures of better quality available on reques

Secukinumab demonstrates superiority over narrow-band ultraviolet B phototherapy in new-onset moderate to severe plaque psoriasis patients: Week 52 results from the STEPIn study.

Biologic treatments have been studied mainly in patients with a long-term history of psoriasis and previous treatment failures. The purpose of this primary analysis of the STEPIn study is to determine whether early intervention with secukinumab in patients with new-onset moderate to severe plaque psoriasis is superior to standard of care treatment with narrow band ultraviolet B (nb-UVB) phototherapy. The STEPIn study is a randomized, open-label, multicentre study to investigate early intervention with 52 weeks of secukinumab 300 mg administered subcutaneously versus standard treatment with nb-UVB phototherapy in patients with new-onset (≤12 months) moderate to severe plaque psoriasis (NCT03020199). The primary and additional secondary endpoints were ≥90% improvement in Psoriasis Area and Severity Index (PASI 90) at Week 52 and Investigator's Global Assessment (IGA mod 2011) 0/1 response at Week 52, respectively. In the secukinumab and nb-UVB study arms, 77/80 and 76/80 randomized patients received at least one dose of study treatment, respectively. The primary endpoint was achieved: 91.1% (70/77) of patients achieved a PASI 90 response at Week 52 in the secukinumab arm versus 42.3% (32/76) in the nb-UVB arm (p < 0.0001, odds ratio [OR] estimate [95% confidence intervals, CI] = 16.3 [5.6, 46.9]). The additional secondary endpoint was also achieved: 85.7% of patients achieved an IGA 0/1 response at Week 52 in the secukinumab arm versus 36.8% in the nb-UVB arm (p < 0.0001). The safety data were consistent with the safety profiles of secukinumab and nb-UVB with no new or unexpected safety signals. Secukinumab was superior to nb-UVB in treating patients with new-onset moderate to severe plaque psoriasis. The high and sustained skin clearance observed indicates that biologic treatment for psoriasis may be more effective if used early in the disease course