The wrist is not the brain: Estimation of sleep by clinical and consumer wearable actigraphy devices is impacted by multiple patient‐ and device‐specific factors

Clinical actigraphy devices provide adequate estimates of some sleep measures across large groups. In practice, providers are asked to apply clinical or consumer wearable data to individual patient assessments. Inter‐individual variability in device performance will impact such patient‐specific interpretation. We assessed two devices, clinical and consumer, to determine the magnitude and predictors of this individual‐level variability. One hundred and two patients (55 [53.9%] female; 56.4 [±16.3] years old) undergoing polysomnography wore Jawbone UP3 and/or Actiwatch2. Device total sleep time, sleep efficiency, wake after sleep onset and sleep latency were compared with polysomnography. Demographics, sleep architecture and clinical measures were compared to device performance. Actiwatch overestimated total sleep time by 27.2 min (95% confidence limits [CL], 138.3 min over to 84.0 under), overestimated sleep efficiency by 6.8% (95% CL, 34.1% over to 20.5% under), overestimated sleep onset latency by 2.6 min (95% CL, 63.3 over to 58.2 under) and underestimated wake after sleep onset by 50.7 min (95% CL, 162.5 under to 61.2 over). Jawbone overestimated total sleep time by 59.1 min (95% CL, 208.6 min over to 90.5 under) and overestimated sleep efficiency by 14.9% (95% CL, 52.6% over to 22.7% under). In multivariate models, age, sleep onset latency, wake after sleep onset, % N1 and apnea–hypopnea index explained only some of the variance in device performance. Gender also affected performance. Actiwatch and Jawbone mis‐estimate sleep measures with very wide confidence limits and accuracy varies with multiple patient‐level characteristics. Given these large individual inaccuracies, data from these devices must be applied only with extreme caution in clinical practice.     

Act global,but think local: accountability at the frontlines

There is a worrying divergence between the way that sexual and reproductive health and rights problems and solutions are framed in advocacy at the global level and the complex reality that people experience in health services on the ground. An analysis of approaches to accountability used in advocacy at these different levels highlights the different assumptions at play as to how change happens. This paper makes the case for a reinvigorated approach to accountability that begins with the dynamics of power at the frontlines, where people encounter health providers and institutions. Conventional approaches to accountability avoid grappling with these dynamics, and as a result, many accountability efforts do not lead to transformative change. Implementation science and systems science are promising sources for fresh approaches, beginning with the understanding of health systems as complex adaptive systems embedded in the broader political dynamics of their societies. By drawing insights from disciplines such as political economy, ethnography, and organizational change management – and applying them creatively to the experience of people in health systems – the workings of power can begin to be uncovered and tackled, sharpening accountability towards those whose health and rights are at stake and generating meaningful change.     

Accessing Maternity Care in Rural Canada: There's More to the Story Than Distance to a Doctor

Drawing upon a comparative, qualitative study of the experiences of rural women accessing maternity care in two Canadian provinces, we demonstrate that availability of services, having economic and informational resources to access the services offered, and the appropriateness of those services in terms of gender, continuity of care, confidentiality, quality of care, and cultural fit are key to an accurate understanding of health care access. We explore the implications of living rurally on each of these dimensions, thereby revealing both gaps in and solutions to rural maternity care access that narrower, proximity-based definitions miss.     

Survey of sibling and peer visitation policies in southern California hospitals

A survey of southern California hospitals identified current visitation policies and the rationale for the restrictions of siblings and peers. Questionnaires mailed to the nursing administrators of 212 hospitals having designated pediatric beds indicated that the majority allowed some form of sibling visitation. The rationales for restriction most frequently given were prevention of infection and spread of communicable disease. The results indicate a gap between sibling visitation research and the theoretical rationale given to support restrictive policies.     

Music in mind, a randomized controlled trial of music therapy for young people with behavioural and emotional problems: study protocol

porter s., holmes v., mclaughlin k., lynn f., cardwell c., braiden h.-j., doran j. & rogan s. (2012)?Music in mind, a randomized controlled trial of music therapy for young people with behavioural and emotional problems: study protocol. Journal of Advanced Nursing68(10), 2349-2358. ABSTRACT: Aims. This article is a report of a trial protocol to determine if improvizational music therapy leads to clinically significant improvement in communication and interaction skills for young people experiencing social, emotional or behavioural problems. Background. Music therapy is often considered an effective intervention for young people experiencing social, emotional or behavioural difficulties. However, this assumption lacks empirical evidence. Study design. Music in mind is a multi-centred single-blind randomized controlled trial involving 200 young people (aged 8-16?years) and their parents. Eligible participants will have a working diagnosis within the ambit of International Classification of Disease 10 Mental and Behavioural Disorders and will be recruited over 15?months from six centres within the Child and Adolescent Mental Health Services of a large health and social care trust in Northern Ireland. Participants will be randomly allocated in a 1:1 ratio to receive standard care alone or standard care plus 12 weekly music therapy sessions delivered by the Northern Ireland Music Therapy Trust. Baseline data will be collected from young people and their parents using standardized outcome measures for communicative and interaction skills (primary endpoint), self-esteem, social functioning, depression and family functioning. Follow-up data will be collected 1 and 13?weeks after the final music therapy session. A cost-effectiveness analysis will also be carried out. Discussion. This study will be the largest trial to date examining the effect of music therapy on young people experiencing social, emotional or behavioural difficulties and will provide empirical evidence for the use of music therapy among this population. Trial registration. This study is registered in the ISRCTN Register, ISRCTN96352204. Ethical approval was gained in October 2010.