Management of Sleep Disorders in Children With Neurodevelopmental Disorders: A Review

Neurodevelopmental disorders (NDDs) are defined as a group of disorders caused by changes in early brain development, resulting in behavioral and cognitive alterations in sensory and motor systems, speech, and language. NDDs affect approximately 1–2% of the general population. Up to 80% of children with NDDs are reported to have disrupted sleep; subsequent deleterious effects on daytime behaviors, cognition, growth, and overall development of the child are commonly reported. Examples of NDDs discussed in this review include autism spectrum disorder, cerebral palsy, Rett syndrome, Angelman syndrome, Williams syndrome, and Smith‐Magenis syndrome. The etiology of sleep disorders in children with NDDs is largely heterogeneous and disease specific. The diagnosis and management of sleep disorders in this population are complex, and little high‐quality data exist to guide a consistent approach to therapy. Managing sleep disorders in children with NDDs is critical both for the child and for the family but is often frustrating due to the refractory nature of the problem. Sleep hygiene must be implemented as first‐line therapy; if sleep hygiene alone fails, it should be combined with pharmacologic management. The available evidence for the use of common pharmacologic interventions, such as iron supplementation and melatonin, as well as less common interventions, such as melatonin receptor agonists, clonidine, gabapentin, hypnotics, trazodone, and atypical antipsychotics is reviewed. Further, parents and caregivers should be provided with appropriate education on the nature of the sleep disorders and the expectation for modest pharmacologic benefit, at best. Additional data from well‐designed trials in children with NDDs are desperately needed to gain a better understanding of sleep pharmacotherapy including efficacy and safety implications. Until then, clinicians must rely on the limited available data, as well as clinical expertise, when managing sleep disorders in the population of children with NDDs.     

Pharmacological and Non-pharmacological Treatments of Sleep Disorders in Parkinson's Disease

Sleep disorders are one of the most common non-motor symptoms in Parkinson''s disease (PD). It can cause a notable decrease in quality of life and functioning in PD patients, as well as place a huge burden on both patients and caregivers. The most cited sleep disorders in PD included insomnia, restless legs syndrome (RLS), rapid eye movement (REM), sleep behavior disorders (RBD), excessive daytime sleepiness (EDS) and sleep disordered breathing (SDB), which can appear alone or several at the same time. In this review, we listed the recommended pharmacological treatments for common sleep disorders in PD, and discussed the recommended dosages, benefits and side effects of relative drugs. We also discussed non-pharmacological treatments to improve sleep quality, including sleep hygiene education, exercise, deep brain stimulation, cognitive behavior therapy and complementary therapies. We tried to find proper interventions for different types of sleep disorders in PD, while minimizing relative side effects.     

Zebrafish as a Tool in the Study of Sleep and Memory-related Disorders

Sleep is an evolutionarily conserved phenomenon, being an important biological necessity for the learning process and memory consolidation. The brain displays two types of electrical activity during sleep: slow-wave activity or Non-Rapid Eye Movement (NREM) sleep, and desynchronized brain wave activity or Rapid Eye Movement (REM) sleep. There are many theories regarding “Why we need to sleep?”; one of them is the synaptic homeostasis. This theory suggests the role of sleep in the restoration of synaptic homeostasis, which is destabilized by synaptic strengthening triggered by learning during waking and by synaptogenesis during development. Sleep diminishes the plasticity load on neurons and other cells to normalize synaptic strength whereas it reestablishes neuronal selectivity and the ability to learn, leading to the consolidation and integration of memories. The use of zebrafish as a tool to assess sleep and its disorders is growing, although sleep in this animal is not yet divided, for example, into REM and NREM states. However, zebrafish are known to have a regulated daytime circadian rhythm, and their sleep state is characterized by periods of inactivity accompanied by an increase in arousal threshold, preference for resting place, and the “rebound sleep effect” phenomenon, which causes an increased slow-wave activity after a forced waking period. In addition, drugs known to modulate sleep, such as melatonin, nootropics, and nicotine have been tested in zebrafish. In this review, we discuss the use of zebrafish as a model to investigate sleep mechanisms and their regulation, demonstrating this species as a promising model for sleep research.     

Stability of Comorbid Psychiatric Diagnosis Among Youths in Treatment and Aftercare for Alcohol Use Disorders

Abstract

Objectives: To examine the stability of comorbid psychiatric diagnoses among a sample of 50 adolescents in cognitive-behaviorally-based treatment for alcohol and other substance use disorders (AOSUD).

Methods: A standardized psychiatric interview was administered at baseline and 12 month later to obtain current comorbid psychiatric disorders. Chi square and Wilconxon sign tests coefficients were used to examine changes in threshold status by type of disorder. Pearson's coefficients were used to identify correlates with improvements in threshold status, include the need for alcohol treatment and alcohol consumption at follow-up.

Results: Diagnostic status changes considerably over time. Prevalence rates for comorbid disorders overall declined. Only declines in mood and externalizing disorders achieved statistical significance. Improvements were positively correlated with mental health service utilization and negatively correlated with the need for alcohol treatment and consumption at 12 months.

Conclusions: Further investigation on the stability and change in diagnostic status of AOSUD youths is warranted.     

阻塞性睡眠呼吸暂停低通气综合征患者觉醒与日间嗜睡的关系

目的：探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者睡眠中觉醒与日间嗜睡的关系及持续气道正压通气（CPAP）对觉醒和日间嗜睡的治疗效应。方法：62例OSAHS患者和12例单纯鼾症患者均记录Epworth评分（EP）、睡眠潜伏期（SL）、呼吸紊乱指数（AHI）、最低血氧饱和度（minSaO2）、氧减饱和度指数（ODI4）、氧饱和度低于90％时间百分比（SLT90％）及呼吸紊乱相关觉醒指数（B-ArI），并将EP、SL分别与B-ArI、minSaO2、ODI4、SLT90％作多元线性回归和相关分析，并比较12例OSAHS患者CPAP治疗前后各项指标变化。结果：EP和SL均与B-Arl关系最密切（EP：R=0．708，R^2=0．502，F=72．539，P〈0．001；SL：R=0．534，R^2=0．285，F=28．673，P〈0．001）。CPAP治疗后B-ArI、EP显著降低。SL显著增加（P〈0．001）。结论：OSAHS患者睡眠中觉醒与日间嗜睡相关，B-ArI可以预计主客观日间嗜睡程度。CPAP对觉醒和日间嗜睡有很好的治疗效应。     

The Neurobiological Mechanisms and Treatments of REM Sleep Disturbances in Depression

Most depressed patients suffer from sleep abnormalities, which are one of the critical symptoms of depression. They are robust risk factors for the initiation and development of depression. Studies about sleep electroencephalograms have shown characteristic changes in depression such as reductions in non-rapid eye movement sleep production, disruptions of sleep continuity and disinhibition of rapid eye movement (REM) sleep. REM sleep alterations include a decrease in REM sleep latency, an increase in REM sleep duration and REM sleep density with respect to depressive episodes. Emotional brain processing dependent on the normal sleep-wake regulation seems to be failed in depression, which also promotes the development of clinical depression. Also, REM sleep alterations have been considered as biomarkers of depression. The disturbances of norepinephrine and serotonin systems may contribute to REM sleep abnormalities in depression. Lastly, this review also discusses the effects of different antidepressants on REM sleep disturbances in depression.     

互联网药学服务模式在儿童癫痫管理中的应用

[摘要]目的：探讨互联网药学服务模式在儿童癫痫管理中的应用效果。方法：采用临床随机对照研究方法,选取2020年1月1日至2022年1月31日就诊于我院的190例癫痫患儿加入互联网药学服务平台为研究组,同期就诊未加入互联网药学服务平台的190例癫痫患儿为对照组。通过Morisky用药依从性问卷调查,自主设计癫痫患儿药学服务管理评估表,了解患儿一般资料、药物治疗信息和癫痫控制情况。结果：问卷调查结果显示,研究组患儿监护人对癫痫相关知识的了解、癫痫发作的判断、患儿用药管理水平等优于对照组（P<0.05）。研究组患儿癫痫有效控制为187例（98.42%）,优于对照组的168例（88.42%）,差异有统计学意义（χ2=15.457,P<0.01）。研究组患儿治疗依从性好48例（25.26%）,对照组为19例（10.00%）,差异有统计学意义（χ2=145.207,P<0.01）。结论：在儿童癫痫管理过程中,基于互联网药学服务模式,可有效提高患儿用药依从性,改善患儿癫痫控制率,且管理规范、操作简单、易被接受,可作为慢病管理的一种手段。     

The Adolescent Community Reinforcement Approach (A-CRA) as a Model Paradigm for the Management of Adolescents With Substance Use Disorders and Co-Occurring Psychiatric Disorders

ABSTRACT. Background: Integrated treatment for youth with substance use disorders (SUDs) and co-occurring psychiatric disorders is recommended; however, there are few studies that have evaluated integrated treatment approaches. Methods: This paper includes a brief review of cognitive-behavioral and family therapies, since they have been demonstrated to be effective treatments for the disorders that commonly co-occur with substance use. It also describes how an integrated treatment paradigm has been implemented using one Empirically Supported Treatment, the Adolescent Community Reinforcement Approach (A-CRA). Results: There is existing research that supports the use of several A-CRA procedures to treat substance use and commonly co-occurring psychiatric disorders. Conclusions: In the absence of further research, it is reasonable in the interim to train clinicians in treatments that incorporate components that have been found to be effective for both substance use and commonly co-occurring psychiatric disorders. These treatments can then be adapted as needed based on an individual youth's set of problems. Further research is needed to test treatments for various combinations of SUDs and psychiatric disorders (i.e., depression, trauma-related problems, conduct disorder/behavior problems, and attention-deficit/hyperactivity disorder [ADHD]).     

A call for ethical code enrichment in complementary and alternative healthcare professions

Ethics are a key underpinning to health care. Complementary and alternative practices are no exception. The ethical codes of practice within popular complementary and alternative medicines are evaluated. The results and their significance are discussed.     

抽验药品应实施“五定”

本文根据当前抽验药品存在的问题，建议卫生行政部门应对药品抽验加强监督管理，实施“五定”，即定考核模式、定考核期限、定公布方式、定抽验人员、定查处追踪。     

The Relationship Between Generalized Anxiety Symptoms and Treatment Dropout Among Women in Residential Treatment for Substance Use Disorders

Background: Generalized anxiety disorder (GAD) co-occurs with substance use disorders (SUDs) at an alarmingly high rate, and the presence of anxiety is associated with an increased risk for relapse to substance use following treatment. Furthermore, comorbid SUDs and other forms of psychopathology are associated with an increased risk for leaving treatment against medical advice (AMA). Objective and Method: Research has yet to examine whether the presence of GAD symptoms is associated with leaving treatment AMA in SUDs populations. Thus, the current study sought to address this important gap in the literature by examining this relationship among a sample of 122 women in residential treatment for SUDs. Results: Results demonstrated that GAD symptoms were significantly associated with the decision to leave treatment AMA after controlling for age, education, problematic alcohol and drug use, and depression symptoms. Conclusions/Importance: Our finding indicates the potential importance of assessing and targeting GAD in treatment for SUDs, which may increase treatment compliance.     

基于FMEA法的住院药房智能麻精药品管理系统的构建和应用

目的 通过失效模式与效应分析法(failure mode and effect analysis,FMEA)的实证性研究构建麻精药品全闭环追溯体系,优化药师及护士操作规范,提升麻精药品管理水平及患者用药安全。方法 采用FMEA法识别麻精药品管理全流程的风险点,通过计算风险优先值(risk priority number,RPN)确定优先改善的风险点,制订相应的改进措施,并对实施效果进行评价。结果 在苏州大学附属第二医院麻精药品管理过程中共找出处方不规范、无法完全实现批号追踪、空安瓿回收率低、废弃药品处置不规范等9个中高风险等级的失效模式。经优化改善后,RPN值均 ≤ 20,共下降312个RPN,下降幅度达72.6%。智能麻精药品管理系统顺利运行,处方修改率由11.56%下降至0.95%,差异具有统计学意义(P<0.05);异常事件的发生由每月(6.67±0.58)件下降至0件;人力成本显著下降;其他诸如空安瓿回收率、麻精药品批号管理准确率、废弃药品处置规范率、麻精药品专用账册规范率均显著提高,差异均具有统计学意义(P<0.05)。结论 运用FMEA方法显著降低了住院药房麻精药品管理的风险。智能麻精药品管理系统的应用,不仅保证了麻精药品全程可追溯,也极大便利了医务人员的操作。     

基层药检所开展内审与管理评审应关注的重要环节

目的探讨基层药检所开展实验室内审和管理评审时应关注的几个重要环节。方法对内审和管理评审的过程进行分析。结果应高度重视内审和管理评审的每个过程。结论要使内审成为质量管理工作的大检查,管理评审成为质量管理工作的年终大检阅。     

妇产科病房护理组长在护理管理中的职能和作用

目的探讨妇产科病房设立护理组长在护理管理中的职能和作用。方法结合我妇产科病房的护理现状,合理、公开的选拔护理责任组长,比较设立护理组长之后与设立护理组长之前,患者出院满意度以及护士护理文书书写情况。结果设立护理组长之后,住院患者的满意度,护理组长工作方法的实施对护理质量的提高有了明显的效果。结论护理组长的设立体现了护士的分层级使用的理念,激发了护理人员工作的积极性,提高了护理质量。     

药检人员考核和经费管理模式探讨

结合药检事业建设的实际,探讨了一套定量考核药检人员和管理药检经费的办法。经初步应用后,大大提高了药检所的工作效率,经济实力和社会效益。     

美国openFDA数据公开对我国食品药品监管数据管理的启示

目的：分析美国食品药品管理局（FDA）公共数据开放项目（openFDA）的启动背景、运行模式和管理经验,为我国食品药品监管数据管理工作提供参考。方法：采用文献研究的方法,对FDA政府网站有关专栏和openFDA项目网站以及在中国知网等数据库中检索到的文献资料进行分析研究。结果与结论：openFDA项目自开展以来积累了大量数据,采取提供应用程序接口、提供数据资料直接下载,以及建立开发者社区为其提供交流和分享的平台多种方式进行公共数据开放,并已取得了一定成效,值得思考借鉴。     

食品药品检验机构业务管理探讨

目的 探讨如何在科学检验理念指导下有效开展食品药品业务管理工作.方法 对具体工作内容、业务管理的新模式及工作体会进行全面阐述.结果与结论 以科学检验理念为指导,实施新的业务管理模式,确保食品药品检验机构业务工作顺利开展.