Hospital Noise Fractures Sleep, Slows Healing

I found this article/study very interesting as I am a big believer in hospital stays and feel that they contribute positively to my health. What about you? Read the article and then tell me what you think!!

Nighttime noise in hospitals adds up to poor sleep, which may hurt healing when patients need it most, researchers found. 

In a laboratory sleep study, recorded hospital sounds of overhead paging, IV alarms, squeaky carts, and the like disrupted sleep and raised heart rates, Orfeu M. Buxton, PhD, of Harvard and Brigham and Women's Hospital in Boston, and colleagues reported.
Electronic alert sounds like ringing phones and IV alarms were the most "potent" in arousing sleepers, disrupting normal sleep brain wave patterns more than half of the time, even when set at their quietest settings. 

Likewise, staff talking and voice paging at a level of 50 dB -- quieter than normal conversation -- disrupted sleep half of the time in the study, which appeared in the June 19 issue of the Annals of Internal Medicine. 

"Preservation of patients' sleep should be a priority for contributing to improved clinical outcomes for patients who are hospitalized," Buxton's group wrote. 

Those benefits might include lower sedation requirements and shorter hospital stays, and even lower incidence of delirium in the intensive care unit, they suggested. 

Many centers contacted by ABC News in collaboration with MedPage Today have started implementing various strategies to limit night noise, which is consistently a top complaint from inpatients. 

That's important to tackle not only for the sake of patients but also for the hospital's reputation, Vineet Arora, MD, of the University of Chicago, commented in an email.
"Noise is a publicly reported quality measure for U.S. hospitals in CMS Hospital Compare [part of the HCAPS survey] and only half of patients report their rooms are kept quiet at night," Arora wrote. 

Common strategies cited were putting posters or stoplight-style monitors in hallways to remind staff and visitors to keep voices down, a switch to visual paging systems, and setting up "quiet time" hours. 

The study included 12 healthy adults who slept in a sound-dampened sleep lab for polysomnography over three nights. 

After a run-in night, participants were exposed to 14 common sounds -- such as voices, IV alarm, phone, ice machine, toilet flush, laundry cart, outside traffic, and helicopter noise -- played at levels increasing from 40 to 70 dB during specific sleep stages to test the impact.
Sleep was easier to disrupt in the phase after the transition into sleep, called N2, that adults spend most of their time asleep in, compared with the next deeper, slow-wave sleep phase called N3 or the rapid eye movement phase (REM, both P<0.001). 

Overall, as expected, louder sounds were more likely to disturb brain wave patterns during sleep. 

Arousal occurred at lower sound levels on the third night than on the second night, suggesting some sensitization to nighttime noise in the hospital. 

Heart rate jumped about 10 bpm when a sound fully roused a sleeper. 

These results likely underestimated the impact of noise on sleep among inpatients due to the young population studied, whereas the typical hospitalized patient is older with medical and psychiatric conditions, as well as pain and medication use, all of which contribute to a harder time reaching the deep N3 stage of sleep, Buxton's group cautioned. 

Another limitation in that regard was that noise exposure was sequential, kept to 10 seconds or less, and halted if a participant started to wake up, which is not the case in a real hospital setting, the investigators added.

Original article: http://www.medpagetoday.com/article.cfm?tbid=33223#.T9i_EOwNECE.twitter

Can you relate? I sure can, but I still think the positives of a hospital stay outweigh the negative. You?

Intrahospital Weight and Aerobic Training in Children With Cystic Fibrosis

Abstract

Purpose: The purpose of our study was to assess the effects of an 8-wk intrahospital combined circuit weight and aerobic training program performed by children with cystic fibrosis (of low–moderate severity and stable clinical condition) on the following outcomes: cardiorespiratory fitness (V˙O_2peak) and muscle strength (five-repetition maximum (5RM) bench press, 5RM leg press, and 5RM seated row) (primary outcomes) and pulmonary function (forced vital capacity, forced expiratory volume in 1 s), weight, body composition, functional mobility (Timed Up and Down Stairs and 3-m Timed Up and Go tests), and quality of life (secondary outcomes). We also determined the effects of a detraining period (4 wk) on the aforementioned outcomes.

Methods: We performed a randomized controlled trial design. Eleven participants in each group (controls: 7 boys, age = 11 ± 3 yr, body mass index = 17.2 ± 0.8 kgöm⁻² (mean ± SEM); intervention: 6 boys, age = 10 ± 2 yr, body mass index = 18.4 ± 1.0 kgöm⁻²) started the study.

Results: Adherence to training averaged 95.1% ± 7.4%. We observed a significant group × time interaction effect (P = 0.036) for V˙O_2peak. In the intervention group, V˙O_2peak significantly increased with training by 3.9 mLökg⁻¹Imin⁻¹ (95% confidence interval = 1.8–6.1 mLökg⁻¹Imin⁻¹, P = 0.002), whereas it decreased during the detraining period (−3.4 mLökg⁻¹Imin⁻¹, 95% confidence interval = −5.7 to −1.7 mLökg⁻¹Imin⁻¹, P = 0.001). In contrast, no significant changes were observed during the study period within the control group. Although significant improvements were also observed after training for all 5RM strength tests (P < 0.001 for the interaction effect), the training improvements were not significantly decreased after the detraining period in the intervention group (all P > 0.1 for after training vs detraining). We found no significant training benefits in any of the secondary outcomes.

Conclusions: A short-term combined circuit weight and aerobic training program performed in a hospital setting induces significant benefits in the cardiorespiratory fitness and muscle strength of children with cystic fibrosis.

Full article can be found at http://www.medscape.com/viewarticle/756304?src=nl_topic

The Power of Placebo

In a recent issue of the New Yorker, long-time staff writer Michael Specter explored the nature of the placebo effect in medicine, primarily by describing the work of Ted Kaptchuk, who directs Harvard University’s Program in Placebo Studies and the Therapeutic Encounter (PiPS). The program’s mission is “to examine the placebo response and the implications of medical ritual, the patient-provider relationship, cultural context, and the power of imagination and hope in the healing process. Through endeavors in the clinical, basic, and social sciences, bioethics, the history of science and philosophy, PiPS seeks to elucidate, quantify, optimize and reaffirm the humanistic and more intangible dimensions of health care.”

Kaptchuk, who studied Chinese medicine in Macau and practiced acupuncture for many years, is arguing for a shift in contemporary medicine away from high-tech and pure science to a greater emphasis on healing. Having recently received funding from the National Institutes of Health, he and his colleagues are undertaking neuroimaging and molecular studies to understand the biological underpinnings of the placebo response.

In one study, he and his group acknowledged that a problem in directly exploring the placebo effect in a clinical setting was the use of deception — not letting patients and providers know of they are receiving an active drug or not. So they designed a randomized study in which patients with irritable bowel syndrome were given pills they were told were “an inert substance, like sugar pills” or no treatment. After 21 days, patients given the placebo had significantly different changes on global improvement scores (5 versus 3.9, P=0.002) and symptom severity (P=0.03).

In another study, patients with asthma were randomized to treatment with an albuterol inhaler, a placebo inhaler, sham acupuncture, or no treatment. The albuterol group experienced 20% improvement in forced expiratory volume in one second (FEV₁) measured on spirometry, and the other three groups all improved by 7%. However, when patients were asked if they felt better, 50% on albuterol reported improvements, as did 45% of those using the placebo inhaler, and 46% of those who had sham acupuncture, compared with only 21% of those who had no treatment (P<0.001). The researchers concluded that, while objective measures such as FEV1 are important in asthma care, “other outcomes such as emergency room visits and quality-of-life metrics may be more clinically relevant to patients and physicians.”

Specter concludes his article with a personal anecdote. He had been experiencing chest pain and was worried, being an overstressed middle-aged man, so went to his doctor, who conducted a careful examination. The physician told him he was fine, but needed to relax — and the pain simply disappeared. This was an example of “exactly the type of ritual that, according to Kaptchuk, will have to play a critical role in the future of American health care.

So what do you think should be the role of placebo — if any — in tomorrow’s medicine?

Original article: The Power of Placebo http://bit.ly/t39hKo from @medpagetoday

Bone Health, Daily Physical Activity, and Exercise Tolerance in Patients With Cystic Fibrosis

Abstract

Background: Daily physical activity (PA) may be an excellent tool for the maintenance of bone health in patients with cystic fibrosis (CF). The aim of this study was to analyze the possible association between physical capacity and activity and bone mineral density (BMD) in young adults with CF. A secondary goal was to evaluate vertebral fractures in this population.

Methods: A cross-sectional study was conducted in 50 patients with CF who were clinically stable and aged > 16 years but not lung transplant recipients. PA was quantified with a portable motion monitor (BodyMedia Fit Armband). Cardiopulmonary exercise and 6-min walk tests were used to assess exercise capacity. BMD was obtained from dual-energy x-ray absorptiometry of the lumbar column, hip, and whole body. To analyze vertebral fractures and deformity, we performed the Genant and Cobb methods.

Results: Daily PA time at low (3-4.8 metabolic equivalent tasks [METs]) and moderate (4.8-7.2 METs) intensity, respectively, was correlated with Z score (BMD) of the lumbar column (r = 0.36, P < .01 and r = 0.59, P < .001), the neck of femur (r = 0.51, P < .001 and r = 0.72, P < .001), and the total hip (r = 0.54, P < .001 and r = 0.74, P < .001). PA, BMI, age, and sex were predictors of BMD. Vertebral fractures correlated with kyphosis (r = 0.42, P = .02), but not with BMD. Patients who were mildly and severely affected differed in vertebral fracture rate and kyphosis prevalence (P = .002 and P = .013, respectively).

Conclusions: The most active patients with better exercise capacity had higher BMD. Those with more affected pulmonary function had a greater prevalence of vertebral fractures and dorsal kyphosis.

1. Sergio Tejero García, MD, PhD,
2. Miguel A. Giráldez Sánchez, MD, PhD,
3. Pilar Cejudo, MD, PhD,
4. Esther Quintana Gallego, MD, PhD,
5. Javier Dapena, MD, PhD,
6. Rosario García Jiménez, MD, PhD,
7. Pedro Cano Luis, MD, PhD and
8. Ignacio Gómez de Terreros, MD, PhD

Placebo Effect Powerful in Asthma

This article was originally posted on Medpagetoday.com

Asthma inhalers have a real impact on airways, but the symptom relief isn't any greater than that achieved with placebos, researchers found.

Stable asthma patients reported the same degree of symptom improvement with inhalation of albuterol as occurred with a placebo inhaler or sham acupuncture (50%, 45%, and 46% improvement, respectively, P=NS) in a blinded pilot study led by Michael E. Wechsler, MD, of Harvard and Brigham and Women's Hospital in Boston.

All three were equally better than no treatment at all (21% improvement, P<0.001), they reported in the July 14 issue of the New England Journal of Medicine.

"Placebo effects can be clinically meaningful and can rival the effects of active medication in patients with asthma," the group concluded in the paper.

Yet the results also suggested that physicians need to keep a close eye on objective measures of asthma control, Wechsler and colleagues noted.

Albuterol had a strong objective effect on airflow, with a mean 20% improvement in forced expiratory volume in 1 second (FEV₁) -- nearly three times the 7% boost seen in all three other groups (P<0.001).

But "patients could not reliably detect the difference between this robust effect of the active drug and the effects of inhaled placebo and sham acupuncture," the researchers warned.

So "subjective improvement in asthma should be interpreted with caution and objective outcomes should be more heavily relied on for optimal asthma care," they recommended.

However, patients' subjective experiences are not wrong simply because they don't fit the objective facts of FEV₁ and actually should trump physician judgment in such symptom-defined conditions, Daniel E. Moerman, PhD, of the University of Michigan in Dearborn, argued in an accompanying editorial.

"It is the subjective symptoms that brought these patients to medical care in the first place," he wrote. "They came because they were wheezing and felt suffocated, not because they had a reduced FEV₁."

A treatment should be acceptable as long as it yields significant improvement for patients, has a reasonable cost, and doesn't have negative effects over the short or long term, Moerman suggested.

The study included 46 patients randomized to double-blind treatment with an albuterol inhaler, a placebo inhaler, sham acupuncture, or no intervention administered in a crossover design during a total of 12 sequential office visits three to seven days apart after a washout period for short- and long-acting bronchodilators.

The no-intervention group acted as a control for the placebo groups, which few prospective studies have tried, the researchers noted.

The most likely explanation for the greater efficacy of placebo was expectation of improvement as "the mere ritual of treatment may affect patients' self-monitoring and subjective experience of their disease," they wrote.

The study was limited by use of a nonvalidated subjective measure of asthma symptom improvement that didn't include a measure of worsening as well as by unknown generalizability to chronic asthma, the group cautioned.

Original article can be found here