Conectar
The comparative efficacy of brief behavioral therapy for insomnia (BBTI) remains unclear.
This systematic review and network meta-analysis examined the effectiveness of different BBTI approaches and compared BBTI with other nonpharmacological interventions, such as cognitive behavioral therapy for insomnia (CBT-I).
Three databases were searched from inception to December 27, 2024. Primary outcomes were insomnia severity and sleep quality. Secondary outcomes included total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, and daytime sleepiness. A frequentist network meta-analysis with random-effects modeling was conducted. Heterogeneity was assessed using the I 2 statistic.
Eighteen randomized controlled trials involving 1104 participants (mean age: 52.6 years) were included. Compared with usual care, BBTI significantly reduced insomnia severity (mean difference [MD] = −4.79; 95% confidence interval [CI = −6.05, −3.53]; I 2 = 0%) and improved sleep quality (MD = −3.45; 95% CI [−4.97, −1.94]; I 2 = 0%). BBTI also shortened sleep onset latency (MD = −19.81 min; 95% CI = −30.64, −8.98; I 2 = 17%) and wake after sleep onset (MD = −15.51 min; 95% CI [−22.75, −8.27]; I 2 = 47%) and increased sleep efficiency (MD = 10.78%; 95% CI [7.67%, 13.89%]; I 2 = 8%). No significant differences were found in total sleep time or daytime sleepiness. Face-to-face BBTI and CBT-I demonstrated similar outcomes. Face-to-face BBTI ranked as the most effective approach based on the surface under the cumulative ranking curve.
Face-to-face BBTI is an optimal nonpharmacological option for improving sleep quality and efficiency and reducing insomnia severity, sleep onset latency, and wake after sleep onset.
PROSPERO number: CRD42021242589
To explore post-anaesthesia care unit nurses' perceptions and experiences in managing paediatric emergence delirium, and to understand their experiences in implementing the Cornell Assessment of Paediatric Delirium—Traditional Chinese version tool in clinical practice following delirium-focused education.
This interpretive qualitative study involved 20 nurses in the post-anaesthesia care unit from a medical centre hospital in Taiwan who participated in small group interviews after completing delirium-focused education. Data were collected through semi-structured interviews between October and December 2024 and analysed using a thematic analysis approach.
Five main themes were identified: (1) First impressions and reflexive actions during emergence delirium, (2) Clinical interpretation through observation and elimination, (3) The dual role of parents in emergence delirium management, (4) Negotiating trust and learning with the delirium screening tool and (5) System-level needs and recommendations. Nurses described the chaotic and emotionally charged nature of emergence delirium episodes, the intuitive yet uncertain interpretive work they performed, the complex influence of parental presence, evolving trust in structured assessment tools and systemic barriers that hindered timely emergence delirium recognition.
Nurses face complex clinical, emotional and relational challenges in managing paediatric emergence delirium. Embedding delirium awareness into practice requires sustained training, screening integration and proactive parental engagement.
Findings highlight the need for integrating delirium screening into post-anaesthesia care routines, the need for ongoing education and preparing parents for emergence delirium scenarios to enhance care delivery and safety.
The COREQ checklist was used for reporting.
No patient or public involvement.
To synthesise the evidence on and to compare the diagnostic accuracy of the Nu-DESC and CAM in detecting postoperative delirium among hospitalised patients.
Systematic review and diagnostic meta-analysis.
The PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, ProQuest Dissertations and Theses A&I, and PsycINFO databases were systematically searched from their inception to February 10, 2023.
In total, 10 (n = 1950) and seven (n = 830) reports were included for the Nu-DESC and CAM, respectively. For Nu-DESC and CAM, the pooled sensitivities were 0.69 and 0.65, respectively, while the summary specificities were 0.99 for Nu-DESC and 0.92 for CAM. The pooled specificity differed significantly between the two tools (p < 0.001), despite comparable pooled sensitivities. The duration of stay in the intensive care unit significantly moderated the summary specificity of Nu-DESC (B = −0.0003, p = 0.009). Regarding CAM, the percentage of female participants showed a positive correlation with its pooled sensitivity (B = 0.005, p = 0.02). Furthermore, studies where clinical specialists served as assessors demonstrated a higher summary sensitivity than those assessed by nurses (0.87 vs. 0.25, p = 0.01).
The sensitivities of the Nu-DESC and CAM for detecting postoperative delirium did not achieve optimal levels. Therefore, developing more accurate tools to detect postoperative delirium by integrating features from related risk factors or incorporating technology-based algorithms to enhance the screening capability is warranted.
The study has adhered to PRISMA-DTA guideline.
No patient or public contribution.
The study protocol has been registered on PROSPERO (CRD42023398961)
FreshRSS 