Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. These highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 215-351-2653 or e-mail Angela Collom at firstname.lastname@example.org
For hospitalized patients, adequate sleep is imperative to the healing process. However, hospital noise frequently disrupts patientsí sleep. In a recent national survey, patients revealed that noise levels in and around rooms at night was one of the most significant factors affecting quality-of-care. Researchers studied 12 healthy participants in a sleep laboratory setting to determine how specific hospital noises, and at what levels, disrupted sleep according to type of sleep stage. Sleep stages include REM, or rapid-eye-movement sleep, and the three progressively deeper stages of non-REM sleep. Over three nights, patients in the lab were exposed to hospital-recorded acoustic stimuli. Noises included those that were external to the building (airplane noises, traffic); those that were within the hospital (telephone ringing, paging system, IV alarm sounding); and those that were outside the patient room (conversations, ice machine, laundry cart rolling by). The researchers found that louder sounds were more apt to cause sleep disruption, especially those that were engineered to alert. However, noises such as ice machines, laundry carts, and overhead paging were arousing at relatively low sound levels. Patients achieving REM sleep were less likely to arouse. The researchers noted that the sleep-disruption effects of noise include hypertension, incidence of cardiovascular and coronary heart disease, impaired immune function, elevated stress hormone responses, attention and memory deficits, and depressed mood, making noise reduction an important factor in improving patient care. Noise-conscious policies, procedures, and building design could lead to improved patient sleep and quality-of-care.
Osteoarthritis of the knee is a common and potentially debilitating condition where joint fluid breaks down, removing the cushion the knee joint needs to function properly. Typically, non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed to reduce pain and restore function. Viscosupplementation injections are an alternative treatment option prescribed to patients who do not respond to NSAIDs. Viscosupplementation injections use naturally-occurring lubricants to replace missing fluid. Researchers reviewed 177 reports describing 89 trials to assess the benefits and harms of viscosupplementation for adults with symptomatic knee osteoarthritis. The researchers found that the benefit of viscosupplementation on pain and function in patients with symptomatic osteoarthritis of the knee was minimal (pain) or non-existent (function). Adverse reactions were common and serious. Most frequently, patients experienced adverse events related to the gastrointestinal system, cardiovascular system, cancer, and musculoskeletal system. According to the researchers, the low efficacy and increased risk of serious adverse events and local adverse events (inflammation) should discourage physicians from administering viscosupplemention injections.