Pharmacological interventions to improve sleep in hospitalised adults: a systematic review

Kanji, S. et al. BMJ Open2016;6:e012108

Objectives: Patients often suffer from disturbed sleep in hospital. Poor-quality sleep in hospitalised patients has been associated with significant morbidity and pharmacological sleep aids are often prescribed. The objective of this systematic review is to evaluate the comparative efficacy and safety of pharmacological interventions used for sleep in hospitalised patients.

Setting/participants: We searched MEDLINE, Embase, the Cochrane database and grey literature for prospective studies that evaluated sleep in hospitalised adults after a pharmacological intervention.

Primary and secondary outcome measures: Two reviewers assessed studies for inclusion and extracted data for efficacy outcomes, including sleep efficiency, sleep latency, sleep fragmentation and objectively measured sleep stage distribution. Risk of bias was assessed and meta-analyses were planned contingent upon homogeneity of the included studies.

Results: After screening 1920 citations, 15 studies involving 861 patients were included. Medications studied included benzodiazepines, nonbenzodiazepine sedatives, melatonin, propofol and dexmedetomidine. Five studies were deemed to be of high quality. Heterogeneity and variable outcome reporting precluded meta-analysis in most cases. No consistent trends with respect to sleep efficiency, quality or interruptions were observed identifying a drug or drug class as superior to another or no treatment. Benzodiazepines appeared to be better than no treatment with respect to sleep latency, but this was not consistently demonstrated across all studies. Sleep stage distribution shows that sleep in hospital is dominated by stages N1 and N2.

Conclusions: There is insufficient evidence to suggest that pharmacotherapy improves the quality or quantity of sleep in hospitalised patients suffering from poor sleep. No drug class or specific drug was identified as superior even when compared to placebo or no treatment. Although 15 studies were included, the quality of evidence was limited by their quality and size. Larger, better-designed trials in hospitalised adults are needed.

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Health Check: should we be using alcohol-based hand sanitisers?

McLaws, M-L. The Conversation. Published online: 1 August 2016

They’re everywhere in hospitals, travellers’ backpacks and the aisles of pharmacies in winter, but do we really need to use alcohol-based hand sanitisers? And what should we make of the marketing claims they’re needed to kill germs?

Our research found we touch our face up to 23 times each hour and, of these, ten touches are to our eyes, nose or mouth. So while touching your face with contaminated hands you could be contaminating your hands or yourself with many infections, including influenza, the common cold and diarrhoeal infections. In fact, contaminated hands can spread most infectious diseases.

In developing countries, diarrhoeal diseases are still the biggest killer of children under five years old. The simplest way to prevent bacteria, viruses and parasites that cause deadly diarrhoeal disease is handwashing with clean water and soap.

In industrial nations like ours, diarrhoeal disease is mostly spread by eating contaminated food – usually from unwashed hands during preparation, serving or eating meals.

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Draft guidance from NICE outlines what the best palliative care for children looks like.

NICE pall

Image source: NICE

An estimated 40,000 children and young people are terminally ill in England. The quality of care they receive varies across the country.

Draft guidance from NICE (National Institute for Health and Care Excellence) outlines what the best palliative care for children looks like.

It emphasises the need for infants, children and young people to be treated as individuals and highlights the importance of children and their families being involved in decisions about care.

Play and art as communication

It is key that children are given information in formats they can understand so NICE recommends using music, art and play.

Play is ultimately fun and enjoyable for children.  It offers opportunities for social, emotional and physical development.

Those who study and practice play therapy emphasise that it has a particular importance for children and young people with a life-limiting illness. They suggest that it offers a chance for the child to have normality and opportunities to express themselves in a creative and independent way.

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