Conducive environments reduce sleep disturbances and improve sleep quality: a quality improvement project.

AIM: The current implementation project aimed to improve patients' sleep quality in a hospital by implementing targeted interventions to reduce sleep disturbances. METHODS: The Silent Night project was implemented in two general units of an academic tertiary hospital. The project comprised three phases: preimplementation, implementation, and postimplementation. Patient surveys were administered to obtain patients' perspectives on the sources of noise disturbances at night. Noise-monitoring machines were installed in two wards to obtain objective data on noise levels at night. Concurrently, data were collected on noise-generating activities that were observed. RESULTS: The overall quality of sleep reported by patients improved by 17% (from 73.5 to 88.9%). Patients' survey reported reduced noise disturbances from direct care activities, environmental noise and medical equipment alarms. The mean noise level in the orthopedics unit reduced significantly from 57.04 to 55.22 dB with a corresponding decrease in noise generating activities by 60% (from 362 to 144). In the geriatric unit, the mean noise level increased from 51.36 to 53.12 dB but is within the National Environmental Agency's permissible noise level of 55 dB even though the noise generating activities reduced significantly by 92.2% (from 954 to 74). CONCLUSION: The 'Silent Night' project has successfully reduced noise disturbances generating from environment and nursing care activities and improved patients' sleep quality in the hospital. Sharing sessions regarding sources of noise and the 'Silent Night' poster promoted the awareness of noise disturbances in healthcare professionals, visitors, and patients.

Fracture incidence after liver transplantation: results of a 10-year audit.

BACKGROUND: High rates of fracture following liver transplantation were reported in earlier years, but the impact of subsequent changes in immune suppression and the introduction of bone-protective therapy on fracture rate have not been reported. AIM: The aim of this study was to document clinical fracture incidence during the period 1998-2008 in a single transplant centre, following the introduction of a bone management protocol. DESIGN: It was designed as a retrospective cohort. METHODS: Records were retrieved from 531 of 592 eligible patients in an audit of all patients undergoing a first liver transplant during the 10-year period. All fractures were verified radiologically. RESULTS: The mean follow-up period was 61.4 months. Prior to transplantation 5.6% of patients had a history of fracture. Incident clinical fractures following transplantation were recorded in just 15 (3.5%) patients. The most common fracture site was the spine and the median time from transplant to fracture was 26 months (range 2-83 months). CONCLUSION: There was a low fracture rate in patients undergoing liver transplantation in this centre over the past 10 years. This rate is lower than that in previous reports, which is likely to reflect the use of lower doses of prednisolone for immune suppression and the administration of bone-protective therapy to high-risk patients.

Engineering and design of vessels for sea transport of animals: the Australian design regulations for livestock carriers.

The author outlines the principles underlying the standards employed by the Australian Marine Safety Authority to regulate live animal carriers, vessels used for sea transport of livestock, that operate from Australia. The standards are contained in regulations adopted by the Australian Maritime Safety Authority known as Marine Orders. The Cargo and Cargo Handling-Livestock Marine Order has evolved over time with subsequent 'issues' of the order as a consequence of operational experience and specific research. Recent changes have focused on the need to have adequate redundancy in systems and equipment of ships. A history of the development of these regulations is given and is followed by a description of the principles employed to develop the provisions contained in the regulations.